Hans  von  Gersdorff — 1551  — Contemporary  Color 

Sfostaf)  Cfcarles  ®rent,  MJB. 


Digitized  by  the  Internet  Archive 
in  2016  with  funding  from 
Duke  University  Libraries 


https://archive.org/details/historicalsketch01jenk 


HISTORICAL  SKETCH  OF  AMERICAN 
GYNECOLOGY. 


By  EDWAED  W.  JENKS,  M.  D.,  LL.D., 
Detroit,  Michigan. 


As  in  the  case  of  most  nations,  so  in  that  of  medicine,  of  whose  his- 
tory it  forms  a part,  the  earliest  dawnings  are  traceable  to  tradition, 
and  in  many  instances  the  historian  is  obliged  to  go  back  of  authen- 
ticated records  for  the  material  with  which  to  construct  the  foundation 
of  his  story.  In  writing  a history  of  American  medicine  in  any  of  its 
divisions  this  difficulty  does  not,  however,  present  itself,  for,  like  the 
American  people  itself,  it  arises  from  a foundation  laid  in  centuries  of 
Transatlantic  life.  While,  therefore,  in  essaying  a history  of  the  achieve- 
ments of  American  surgeons  in  the  treatment  of  diseases  peculiar  to 
women  I am  not  obliged  to  analyze  aught  which  is  of  doubtful  authen- 
ticity as  a basis  for  a starting-point,  it  has  seemed  to  me  that  a brief 
resume  of  the  historical  facts  which  form  the  foundation  of  gynecol- 
ogy as  it  exists  in  America  to-day  will  greatly  assist  to  the  clearest  con- 
ception of  the  superstructure.  The  explorations  of  antiquarians  of  later 
years  into  that  which  has  been  hidden  by  the  debris  of  centuries  has, 
moreover,  unearthed  so  many  of  the  prototypes  of  modern  discoveries 
that  a consideration  of  the  latter  could  scarcely  be  held  to  be  complete 
without  a reference  to  their  predecessors  in  the  remote  ages. 

Gynecology  is  singularly  rich  in  illustrations  of  the  belief  that  prog- 
ress is  in  the  direction  of  a circle  rather  than  in  that  of  a straight 
line — “ that  which  hath  been  is,  and  that  which  is  shall  be  and  many 
of  the  brilliant  discoveries  with  which  it  has  been  enriched  in  modern 
times,  and  even  in  America,  were  really  but  rediscoveries  of  discoveries 
which  the  mutations  of  time  have  effaced  from  the  memories  and  the 
records  of  men. 

While  the  current  of  gynecology  as  it  has  flowed  down  to  us  in  an 
ever-widening  stream  from  the  past  is  traceable  with  definite  clearness 
only  to  the  Greeks,  there  is  evidence  that  it  did  not  have  its  origin 
among  that  remarkable  people,  but  that  it  trickled  in  rivulets,  too  small 
for  the  attention  of  the  great  majority  of  explorers,  from  the  people  living 
on  the  Xile.  That  the  stream  was  clearly  recognized  in  the  days  of 
Homer  and  Herodotus  is  attested  in  the  writings  of  those  immortal 

Vol.  I. — 2 17 


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HISTORICAL  SKETCH  OF  AMERICAN  GYNECOLOGY. 


Greeks,  who  wrote  in  terms  of  the  highest  admiration  of  the  skill  and 
the  learning  of  the  physicians  of  Egypt. 

The  physicians  under  the  Ptolemies  were  required  to  regulate  their 
practice  according  to  certain  books,  one  of  which  was  devoted  to  diseases 
peculiar  to  women.  These  books  were  held  as  sacred,  and  their  authority 
was  thus  unquestionable.  Doubtless,  there  existed  among  a people,  evi- 
dences of  whose  greatness  have  of  more  recent  years  been  so  abundantly 
revealed,  other  works  on  this  subject,  but  Saracen  fanaticism  in  the 
destruction  of  the  Alexandrian  Library  with  its  600,000  volumes  blotted 
out  the  story  of  what  Egypt  once  was,  and  has  left  us  only  to  conjecture. 
When  the  difference  in  the  language  and  political  complexion  of  Greece 
and  Egypt  is  considered  in  connection  with  the  necessarily  limited  in- 
tercommunication of  the  two  peoples,  it  is  but  reasonable  to  suppose 
that  comparatively  little  of  the  learning  of  the  older  civilization  found 
its  way  to  Greece,  and  that  such  inkling  as  we  have  received  through 
the  Greeks  of  the  status  of  Egyptian  medicine  is  very  meagre  when 
compared  with  the  actual  advancement  which  obtained. 

The  destruction  of  the  Alexandrian  Library  has  left  the  writings 
of  Hippocrates,  written  about  450  B.  c.,  the  oldest  extant  containing 
anything  like  a systematic  consideration  of  the  diseases  of  women. 
Moses,  who  was  versed  in  “ all  the  learning  of  the  Egyptians,”  shows 
a remarkable  familiarity  with  the  sexual  peculiarities  of  women,  but 
lie  treats  of  them  in  their  physiology,  and  interests  himself  in  the 
hygiene  of  the  genitalia  rather  than  in  their  diseases. 

In  the  language  of  Adams,  the  learned  commentator  on  the  works 
of  Hippocrates,  “ these  works  furnish  the  most  indubitable  proofs  that 
the  obstetric  art  had  been  cultivated  with  most  extraordinary  ability  at 
an  early  period.”  In  regard  to  gynecology  proper,  these  works  are, 
however,  disappointing  to  him  who  has  been  led  to  admire  and  revere 
the  philosopher  of  Cos  through  a study  of  his  works  on  general  med- 
icine. Hippocrates  advised  the  use  of  aromatic  fumigations  in  amenor- 
rhoea,  which  fumigations  lie  also  recommended  as  a test  of  fertility  in 
the  female.  The  woman  who  did  not  conceive  was  wrapped  in  blanket- 
and  fumigated  from  beneath  ; if  the  scent  passed  through  her  body  to 
the  nostrils  and  mouth,  then  it  was  known  that  she  was  not  unfruitful ! 
While  he  recognized  a causative  relation  between  the  uterus  and  hys- 
teria, he  maintained  that  the  movement  of  the  womb  toward  the  head 
caused  pain  under  the  eyes  and  nose,  with  abundant  and  frothy  saliva  ; 
if  it  moved  toward  the  hypochondrium,  it  caused  vomiting  of  an  acrid, 
burning  matter ; if  it  moved  toward  the  liver,  it  caused  loss  of  speech, 
clenching  of  the  teeth,  and  a livid  skin.  The  remedies  for  these  various 
hysterical  symptoms  were  as  ludicrous  as  their  etiology.  Nulliparae  were 
held  to  be  more  subject  to  menstrual  disorders  than  women  who  had 
borne  children,  for  the  veins  of  the  woman  who  has  given  birth  to  a 


HISTORICAL  SKETCH  OF  AMERICAN  GYNECOLOGY. 


19 


child  carry  oft’  the  menstrual  discharge  more  readily,  because  the  lochial 
discharge  improves  the  circulation.  The  views  of  the  “Father  of 
Medicine”  on  the  treatment  of  uterine  hemorrhage  were,  however, 
more  sensible.  We  discover,  indeed,  in  them  some  of  the  fundamental 
principles  of  the  advanced  methods  of  our  own  day.  His  knowledge 
of  the  relation  of  sympathy  between  the  uterus  and  the  mammae  is 
apparent  in  his  instruction  to  apply  a large  cupping  instrument  to  the 
breast  as  a means  of  staying  uterine  hemorrhage.  His  description  of 
leucorrhoea  and  the  frequent  attendant  systemic  condition  is  graphic, 
although  his  therapy  of  the  affection  is  crude.  The  prolapsed  uterus, 
he  says,  “ hangs  down  like  a scrotum.”  It  should  be  well  washed 
with  astringent  lotions  and  restored  to  its  place,  when  the  woman  must 
be  placed  on  her  back  with  her  legs  crossed  and  tied  together.  That 
Hippocrates  recognized  the  fact  that  a molar  pregnancy  occurring  in  an 
unmarried  woman  impeached  her  virtue  is  evident  from  his  statement 
that  moles  are  caused  by  a superabundance  of  menstrual  blood,  together 
with  a bad  condition  of  the  semen.  He  gives  a clear  differential  diag- 
nosis between  molar  and  true  pregnancy.  His  description  of  cancer 
of  the  uterus  is  clear,  and  his  gloomy  prognosis  in  such  cases  has  not 
been  much  brightened  by  the  advances  made  since  his  day.  We  recog- 
nize in  the  “ pliimus  ” of  his  day  the  modern  stenosis  of  the  os.  He 
recommends  an  application  containing  verdigris  for  its  relief.  His 
remarks  on  atresia  of  the  vagina  and  uterus  command  attention : 
“ Sometimes  the  vagina  becomes  obstructed  after  parturition.  I have 
seen  a case  where  the  parts  were  torn  during  delivery,  causing  excoria- 
tions, after  which  the  parts  became  seriously  inflamed,  so  that  the  lips 
touched  and  became  united  as  in  wounds.  After  the  subsidence  of  the 
inflammation  the  lips,  which  had  reunited,  offered  an  obstacle  to  the  men- 
strual discharge,  preventing  its  free  exit.  It  is  necessary  in  such  a case 
to  dress  the  lacerated  parts  and  cause  cicatrization,  but  it  is  also  neces- 
sary that  the  cicatrix  be  firm  and  complete,  while  it  is  very  difficult 
to  secure  this  result.  In  the  instance  of  which  I speak  all  the  results 
took  place  which  occur  when  the  menses  are  suppressed  by  malforma- 
tion of  the  uterus,  but  the  principal  pain  was  felt  in  the  vagina,  which 
the  woman  found  to  be  occluded.  After  suitable  treatment  the  men- 
strual flow  was  re-established,  the  woman  recovered  her  health,  and 
afterward  bore  children.  If  the  case  had  been  neglected,  the  wound 
would  have  increased  in  size,  and  a cancer  would  have  been  the  final 
result.”  It  is  evident  that  the  subject  of  sterility  received  much  of 
his  attention,  and  his  views  concerning  the  causation  of  the  same  are 
interesting.  He  held  the  cause  to  be  one  or  several  of  the  following : 
“ 1.  Because  the  os  uteri  is  turned  obliquely  from  the  passage  to  it. 
2.  Because  the  inside  of  the  uterus,  being  smooth,  either  naturallv  or 
in  consequence  of  cicatrices  and  ulcers,  does  not  retain  the  semen. 


20 


HISTORICAL  SKETCH  OF  AMERICAN  GYNECOLOGY. 


3.  When,  owing  to  the  suppression  of  the  menses,  any  obstruction 
takes  place  in  the  os  uteri,  it  is  apt  to  prevent  impregnation.  4.  W hen 
impregnation  does  not  take  place,  the  veins  of  the  uterus  become  so 
engorged  with  blood  that  they  do  not  retain  the  semen ; or,  on  the 
contrary,  the  same  effect  may  arise  from  profuse  menstruation,  whereby 
the  retentive  faculty  of  the  vessels  is  weakened  and  a return  of  the 
menstrual  fluid  in  too  great  quantity  may  wash  away  the  semen.  5. 
Prolapsus  uteri,  by  rendering  the  mouth  of  the  uterus  hard  and  cal- 
lous, prevents  impregnation. ” 

Among  the  Romans  there  is  evidence  that  the  diseases  of  woman 
received  especial  attention.  Their  knowledge  was,  however,  mainly 
derived  from  Greece  and  Alexandria,  their  writings  revealing  none 
of  the  originality  of  thought  and  boldness  of  procedure  which  have 
always  marked  progress  in  this  division  of  medicine.  Celsus  was  a 
voluminous  writer,  but  it  is  to  be  regretted  that  so  much  of  such  parts 
of  his  works  as  treated  especially  of  the  diseases  of  women  have  been 
lost  as  to  leave  us  at  best  a very  disjointed  reference  to  the  subject. 
Enough  has,  however,  been  preserved  of  his  writings  and  of  those  of 
Galen  to  convince  us  that  as  early  as  the  first  century  of  the  Chris- 
tian era  the  speculum,  rediscovered  by  Recamier  in  1816,  was  not 
unknown ; that  the  vaginal  touch  was  used  as  a means  of  diagnosis ; 
and  that  ulceration  of  the  womb  and  leueorrhcea  in  its  several  vari- 
eties had  been  recognized.  In  the  excavations  of  Pompeii  and  Her- 
culaneum, overwhelmed  with  lava  from  Mount  Vesuvius  a.  d.  79, 
and  remaining  buried  for  nearly  eighteen  hundred  years,  there  were 
found  among,  other  surgical  instruments,  two  specula,  such  as  were 
probably  in  common  use  at  the  time  of  the  catastrophe. 

Following  the  faint  glimmer  of  light  emitted  from  Rome,  we  have 
a period  of  almost  absolute  darkness  extending  over  five  hundred 
years,  all  of  such  history  of  the  medicine  of  those  years  as  may 
have  been  written  having;  at  last  become  extinct.  At  the  end  of 

<3> 

this  period  we  find  at  work  in  the  library  at  Alexandria  one  fEtius, 
a Greek,  whom  the  fame  of  that  wonderful  collection  had  probably 
attracted  from  his  native  land,  although  the  fact  that  he  refers  occa- 
sionally in  his  writings  to  cases  occurring  under  his  own  eye  gives 
color  to  the  belief  that,  besides  delving  in  the  accumulated  lore,  he 
also  engaged  in  the  practice  of  his  profession.  The  writings  of  Alt  ins. 
compilations  chiefly  from  the  Alexandrian  collection,  having  fortu- 
nately  been  preserved,  we  are  permitted  to  know  through  them  some- 
thing of  the  status  of  medicine  in  Egypt  a millennium  and  a half  ago. 
A study  of  these  writings  will  open  up  a wonderful  revelation  to  those 
who  regard  gynecology  as  peculiarly  a development  of  these  later 
times.  They  consist  of  four  books  ( tetrabiblus ),  each  of  which  i-  in 
turn  subdivided  into  many  chapters.  The  fourth  discourse  of  the 


HISTORICAL  SKETCH  OF  AMERICAN  GYNECOLOGY. 


21 


fourth  book,  containing  one  hundred  and  twelve  chapters  varying  iu 
length  from  a few  lines  to  several  pages,  is  principally  devoted  to 
obstetrics  and  diseases  of  women.  In  it  the  uterus  and  the  ovaries, 
their  structure  and  function,  are  described  with  a degree  of  exactness 
which  both  disposes  of  the  assumption  that  the  ancients  were  ignorant 
of  physiology,  and  proves  that  they  possessed  instruments  for  ocular 
examination  of  the  uterus  (their  dioptra)  and  sounds  for  determining 
its  size  in  the  living  subject.  The  description,  too,  which  is  given  of 
the  methods  in  vogue  for  preventing  the  legitimate  consequences  of 
sexual  congress  and  for  inducing  abortion  proves  that  the  nefarious 
practices  by  means  of  which  the  female  of  our  day  would  accomplish 
the  same  result  are  not  of  modern  origin.  Latero-version,  antever- 
sion,  and  retroversion  of  the  uterus,  and  various  methods  for  the  relief 
of  these  displacements,  are  discussed,  and  mention  is  even  made  of 
the  sound  for  correcting  malpositions  of  that  organ.  Abscess  of  the 
uterus  was  recognized,  and  the  description  of  the  examination  for  its 
diagnosis  and  the  methods  for  its  treatment  would,  barring  certain 
crudities  of  expression,  pass  muster  even  in  the  light  of  our  more 
advanced  knowledge  of  uterine  ailments  and  the  means  of  their 
relief.  The  treatment,  medical  and  surgical,  laid  down  for  pelvic 
abscess  would  do  no  discredit  to  the  modern  gynecologist.  The 
relief  of  stenosis  of  the  os  by  means  of  sponge  tents  is  so  graphically 
described  as  either  to  compel  the  belief  that  the  modern  discoverer  of 
this  use  of  these  devices  derived  his  knowledge  from  the  writings  of 
kEtius,  or  to  cause  the  reader  to  marvel  at  the  remarkable  coincidence. 
Atresia  of  the  vagina  is  discussed,  and  the  operation,  with  instruments 
therefor,  for  its  relief  clearly  described. 

The  next  writer  in  chronological  order  whose  writings  are  preserved 
to  us  is  Paul  of  kEgina,  between  whom  and  kEtius  there  intervenes  a 
century.  This  writer  has  been  accorded  a prominence  which  he  does 
not  merit.  Dr.  Adams,  the  translator  of  the  Sydenham  series,  has 
shown  him  much  consideration.  A studv  of  his  writings  in  connection 
with  those  of  kEtius  reveal  him  to  have  been  a plagiarist.  He  was  at 
most  a compiler,  and  his  efforts  even  in  this  direction  fell  far  short  of 
those  of  the  industrious  and  able  kEtius. 

Following  Paulus  kEgineta  we  have  a millennium  of  darkness,  the 
gloom  being  relieved  only  by  the  uncertain  glints  with  which  the  Sar- 
acens sought  to  make  amends  for  their  damnable  vandalism  in  the 
matter  of  the  Alexandrian  Library.  But  an  insuperable  obstacle  to 
their  progress  in  the  knowledge  of  the  diseases  of  women  presented 
itself  in  the  Moslem  religion,  which  forbade  visual  and  digital  exami- 
nation of  the  female  genitalia,  even  under  conditions  of  the  most  intol- 
erable suffering,  by  male  physicians.  The  ability  of  the  Saracen  physi- 
cians, so  abundantly  illustrated  in  other  departments  of  medicine,  was 


22  HISTORICAL  SKETCH  OF  AMERICAN  GYNECOLOGY. 

therefore  forbidden  an  opportunity  of  manifesting  itself  in  this,  and 
such  knowledge  as  formed  the  basis  of  their  unsatisfactory  practice  in 
gynecology  was  derived  solely  from  the  writings  of  the  Greeks ; and 
the  fact  that  any  treatment  of  a local  nature  which  might  have  been 
deemed  necessary  must  be  applied  by  ignorant  midwives  caused  this 
branch  of  medicine  to  soon  fall  into  desuetude  and  consequent  decay. 
Of  the  Arabian  writers,  Albucasis,  in  the  fourteenth  century,  alone 
seems  to  have  given  it  any  considerable  attention,  and  there  is  internal 
evidence  in  his  writings  that  he  was  a Jew,  and  was  thus  not  hindered 
by  any  religious  scruples  of  his  own  from  pursuing  his  studies  after 
the  manner  proscribed  by  the  Moslem  religion.  He  makes  an  occa- 
sional allusion  to  the  speculum,  but  doubtless  the  circumstances  under 
which  he  lived  made  even  his  employment  of  it  rare.  Although  it  is 
apparent  from  the  writings  of  subsequent  authors,  and  notably  Ambrose 
Pare  (1509-90)  and  Scultetus  (1683),  that  the  instrument  was  not  abso- 
lutely forgotten,  it  is  nevertheless  a fact  that  for  a thousand  years  prior 
to  its  rediscovery  (if  such  it  really  was)  by  Recamier  (1816)  it  was 
practically  a lost  instrument,  and  gynecology  certainly  was  during  this 
millennium  a lost  art. 

While,  as  intimated  at  the  outset,  American  gynecology,  dating  from 
the  earliest  attention  to  this  branch  of  medicine  by  the  profession  of 
this  country,  is  continuous  with  gynecology  as  we  have  traced  it  in 
outline  from  its  earliest  dawn  in  the  Old  World,  its  achievements  prior 
to  the  renaissance  ushered  in  by  Recamier  cannot  be  said  to  have  been 
of  sufficient  importance  to  entitle  it  to  a distinctive  national  name.  It 
must  not  be  inferred  from  this  that  this  division  of  medicine  was  more 
neglected  on  this  side  the  Atlantic  than  on  the  other,  or  that  the  Ainer- 
ican  woman  whose  means  forbade  a visit  to  the  European  centres  was 
obliged  to  suffer  from  her  ailments  without  having  held  out  to  her 
by  native  talent  as  much  hope  as  could  be  promised  abroad.  A hile  it 
may  have  been  true,  as  charged  by  Dr.  Douglass,  that  there  was  in  his 
day  (1717)  “ more  danger  from  the  physicians  of  Boston  than  from  the 
distemper,”  this  condition  of  affairs  had  much  improved  when  the  A ar 
of  Independence  Avas  declared.  The  Avritings  of  Joseph  Osgood  of 
Andover  and  Joseph  Orne  and  Augustus  Holyoke  of  Salem  eA-ince  a 
knowledge  of  the  diseases  of  Avomen  Avhich  was  probably  quite  abreast 
of  that  possessed  by  their  European  contemporaries.  In  the  year  1790, 
nine  years  after  its  organization,  the  Medical  Society  of  Massachusetts 
first  published  such  of  the  contributions  as  Avere  presented  before  that 
body.  Among  these  publications  is  found  an  occasional  article  on 
some  gynecological  subject,  but  the  first  which  was  devoted  to  a subject 
unconnected  with  the  puerperal  condition  Avas  one  entitled  “ The  His- 
tory of  a Hemorrhage  from  a Rupture  on  the  Inside  of  the  Left  Labium 
Pudendi.”  This  Avas  contributed  by  Dr.  Nathaniel  A . Appleton  of 


HISTORICAL  SKETCH  OF  AMERICAN  GYNECOLOGY. 


23 


Boston,  and  appears  in  the  second  part  of  the  first  volume  of  the 
Transactions  of  the  society,  issued  in  the  year  1806. 

The  influence  of  the  teachings  of  Smellie  and  Hunter  very  naturally 
extended  to  the  profession  in  the  colonies,  and  abundant  evidence  of  it 
is  found  in  the  reports  of  cases  in  such  literature  of  the  colonial  days 
as  is  extant.  The  causes,  however,  which  operated  to  the  repression  of 
progress  in  gynecology  were  operative  here  as  in  Europe ; and  while 
we  believe  that  the  latent  energies  of  the  profession  of  the  New  World, 
necessarily  thrown  quite  entirely  on  its  own  resources,  must  in  course 
of  time  have  transcended  in  their  results  the  achievements  of  the  pro- 
fession abroad,  the  struggle  inaugurated  by  the  Declaration  of  Inde- 
pendence diverted  those  energies  into  channels  which  were  incompat- 
ible with  scientific  research.  For  seven  long  years  the  struggle  for 
personal  and  national  existence  not  only  forbade  the  development 
of  the  native  resources,  but  it  also  shut  the  profession  out  from  the 
influence  of  the  mysterious  awakening  from  the  lethargy  of  centuries 
which  was  going  on  in  Europe.  Nor  did  the  cessation  of  hostilities 
leave  the  road  to  professional  progress  free  and  unobstructed.  The  vic- 
tory had  been  achieved,  but  at  a cost  of  life  and  energy  and  treasure 
which  caused  a depression  from  which  it  required  many  years  to  rally. 
Although  the  profession  of  medicine,  which  has  for  its  object  the  health 
of  the  people — the  supreme  law — is  a very  essential  factor  in  national 
growth,  there  are  other  matters  which  are  more  immediately  pressing 
in  seasons  of  great  national  depression — agriculture,  manufactures,  com- 
merce. For  a couple  of  decades  following  the  close  of  the  war  these 
were  held  to  be  of  paramount  concern,  and  it  was  not  until  the  opening 
of  the  present  century  that  the  profession  of  this  country  found  itself 
in  a position  to  devote  even  a portion  of  its  energies  to  the  special 
development  of  any  particular  division  of  the  whole  field  of  medicine 
which  commanded  its  attention. 

It  was  a happy  coincidence  that  the  profession  in  America  found 
itself  sufficiently  recovered  from  the  distractions  of  war  to  permit  of 
its  placing  itself  in  the  line  of  the  movement  in  gynecology  inaugurated 
bv  Hunter  in  England,  and  stimulated  to  unprecedented  activity  by  the 
revival  of  the  speculum  by  Recam ier  in  France.  The  comparative 
leisure  and  wealth  which  followed  in  the  wake  of  the  prosperity  ensured 
by  the  elasticity  of  our  people  made  it  possible  for  the  profession  to 
embrace  the  opportunity,  which,  had  it  presented  a decade  sooner,  would 
of  necessity  have  been  allowed  to  pass  by  unimproved.  The  dawn  of 
the  present  century  found  our  young  men  and  many  of  our  older  prac- 
titioners repairing  to  the  mother-country  and  to  the  various  seats  of 
learning  in  Europe,  and  drinking  in  the  spirit  of  the  revival,  and 
bringing  it  back  with  them  to  these  shores.  Among  these  young  men 
was  one  Ephraim  McDowell,  who  was  born  in  Virginia  in  1771,  and 


24  HISTORICAL  SKETCH  OF  AMERICAN  GYNECOLOGY. 


who  moved  thence  with  his  father  and  the  rest  of  the  family  to  settle 
in  Kentucky  in  the  year  1783.  Young  McDowell  was  accorded  the 
educational  advantages  of  that  early  day  in  that  new  country.  His 
subsequent  writings  show  that  his  literary  acquirements  were  not  of  a 
much  higher  order  than  we  could  have  expected  under  the  impropitious 
circumstances.  After  leaving  school  he  studied  medicine  for  two  or 
three  years  with  a Dr.  Humphreys  of  Staunton,  Virginia,  a graduate 
of  the  University  of  Edinburgh.  When  we  recall  the  contempt  which 
the  physician  educated  abroad  entertained  in  those  days  for  American 
educational  institutions,  we  are  not  surprised  at  finding  no  evidence  of 
McDowell’s  having  attended  any  lectures  in  Philadelphia,  then  the  onlv 
seat  of  medical  education  in  this  country.  At  his  preceptor’s  dictation, 
doubtless,  he  went  to  Edinburgh,  where  during  the  sessions  of  1793 
and  1794  he  attended  lectures  in  the  famous  university,  then  in  the 
zenith  of  its  renown.  Not  fully  satisfied,  however,  with  the  regular 
course  of  the  university  on  the  subject  of  surgery,  he  took  a private 
course  under  Mr.  John  Bell,  a surgeon  noted  alike  for  his  enthusiasm, 
his  eloquence,  his  skill,  and  his  hold  on  the  affections  of  his  students. 
W e have  no  evidence  that  McDowell  ever  graduated.  Mr.  Bell  is  said 
to  have  been  an  enthusiast  on  the  subject  of  organic  diseases  of  the 
ovaries,  and  to  have  even  discussed  the  possibility  of  their  successful 
removal,  although  never  himself  venturing  to  practically  demonstrate 
this  possibility.  Doubtless,  the  young  Kentuckian  resolved  while  under 
the  spell  of  his  teacher’s  enthusiasm  to  undertake  what  that  teacher’s 
timidity,  perhaps,  kept  him  from  attempting,  and  he  returned  to  his 
Western  home  inspired  with  the  high  resolve.  He  settled  in  Danville 
in  1795.  Although  but  twenty-four  years  of  age,  the  fame  of  his 
sojourn  at  foreign  seats  of  learning,  and  of  the  fact  that  he  had  studied 
under  John  Bell,  whose  reputation  had  long  before  crossed  the  seas, 
soon  secured  for  him  a large  clientele.  Patients  soon  flocked  from  all 
parts  of  the  South-west,  and  for  hundreds  of  miles  around  he  had  the 
monopoly  of  the  important  operations.  He  had  been  in  practice  four- 
teen years  when  he  was  consulted  by  a Mrs.  Crawford,  who  suffered 
from  a large  abdominal  tumor  which  a careful  examination  convinced 
McDowell  was  ovarian.  Here  was  the  opportunity,  and  the  man  was 
equal  to  it.  The  teachings  of  Bell  had  fallen  in  fruitful  soil,  and  the 
time  of  their  fruition  had  arrived.  Mrs.  Crawford  was  no  ordinary 
woman,  and  when  McDowell  declared  to  her  that  her  only  hope  lay  in 
the  removal  of  her  tumor,  explaining  to  her  the  fact  that  such  an 
operation  had  never  before  been  undertaken,  and  admonishing  her  of 
the  dangers  which  attended  it,  the  brave  woman  placed  herself  unre- 
servedly in  the  brave  man’s  hands.  The  consultation  was  held  at  Mrs. 
Crawford’s  residence,  sixty  miles  from  Danville,  and  Dr.  McDowell 
made  it  a condition  of  his  operating  that  his  patient  come  to  his  home 


HISTORICAL  SKETCH  OF  AMERICAN  GYNECOLOGY. 


25 


for  the  operation.  The  heroine  travelled  this  distance  on  horseback, 
was  operated  on  in  December,  1809,  she  being  then  forty-seven  years 
of  age,  and  at  the  end  of  twenty-five  days  returned  to  her  home,  where 
she  lived  for  thirty-two  more  years,  during  which  she  enjoyed  for  the 
most  part  excellent  health,  and  died  at  length  in  the  seventy -ninth  year 
of  her  age.  When  we  remember  the  facts  that  this  first  operation  for 
the  removal  of  an  ovarian  tumor  was  performed  before  the  days  of 
anaesthesia,  and  that  Dr.  McDowell  had  none  of  the  advantages  of  the 
trained  assistants  and  perfected  instruments  which  are  now  deemed 
so  essentia]  to  the  success  of  this  operation,  the  courage  of  the  woman 
and  the  skill  and  intelligent  daring  of  the  surgeon  combine  to  form  a 
picture  which  is  unique  for  its  grandeur  in  the  annals  of  surgery. 

Dr.  McDowell’s  delay  in  reporting  this  case  of  ovariotomy  was 
in  singular  contrast  with  the  more  commendable  practice  of  these  later 
days.  Instead  of  immediately  giving  a description  of  his  wonderful 
case  for  the  benefit  of  his  contemporaries,  he  waited  for  seven  years, 
during  which  time  he  successfully  performed  two  other  ovariotomies. 
His  report  of  these  three  cases  appeared  in  the  October  (1816)  issue 
of  the  Eclectic  Repertory  and  Analytical  Review.  It  was  a document 
remarkable  for  its  brevity,  that  portion  of  it  covering  the  case  which 
has  made  his  name  immortal,  and  which  demonstrated  the  practicability 
of  a procedure  which  more  than  any  other  has  lengthened  the  average 
of  woman’s  life  and  diminished  the  sum  of  her  sorrow,  not  occupying 
more  space  than  a page  the  size  of  that  on  which  this  sketch  appears. 
The  incision  was  made  about  three  inches  from  the  musculus  rectus 
abdominis  on  the  left  side,  parallel  to  the  fibres  of  this  muscle,  and 
nine  inches  in  length  and  extending  into  the  abdomen.  The  abdominal 
parietes  were  found  to  be  very  much  contused,  owing,  it  was  supposed, 
to  the  tumor’s  resting  on  the  horn  of  the  saddle  during  the  journey. 
A ligature  was  thrown  around  the  Fallopian  tube  near  the  uterus,  when 
the  tumor  was  cut  open,  and  “ fifteen  pounds  of  a dirty,  gelatinous- 
looking  substance  ” removed.  The  sac  was  afterward  amputated  at  the 
ligature,  and  was  found  to  weigh  seven  pounds  and  a half.  As  soon  as 
the  external  opening  was  made  the  intestines  rushed  out  on  the  table, 
and  so  completely  Avas  the  abdomen  filled  by  the  tumor  that  they  could 
not  be  replaced  during  the  operation,  Avhich  Avas  terminated  in  about 
twenty-five  minutes.  The  Avoman  was  then  placed  on  her  left  side,  so 
as  to  permit  the  blood  to  escape,  after  Avhich  the  external  opening  Avas 
closed  Avith  the  interrupted  suture,  leaving  out  at  the  lower  end  of  the 
incision  the  ligature  Avhich  surrounded  the  Fallopian  tube.  Between 
every  two  stitches  Avas  put  a piece  of  adhesive  plaster,  Avhich,  by  keep- 
ing the  parts  in  contact,  hastened  the  healing  of  the  incision.  The 
usual  dressing  AA'as  then  applied,  the  patient  put  to  bed,  and  placed  on 
a strict  antiphlogistic  regimen.  On  visiting  her  (i ve  days  after,  Dr. 


26  HISTORICAL  SKETCH  OF  AMERICAN  GYNECOLOGY. 


McDowell  was  astonished  to  find  his  patient  engaged  in  making  up 
her  bed. 

The  other  two  cases  occurred  in  negro  women,  and  the  space  devoted 
to  the  consideration  of  both  of  them  is  less  than  that  taken  up  bv  a 
description  of  the  first  operation.  The  whole  report  was  loosely  and 
carelessly  constructed,  and  poorly  calculated  to  inspire  confidence  in  the 
author’s  literary  and  scientific  attainments.  Had  McDowell  been  gritted 
with  facility  of  expression  the  recognition  of  his  operation  would 
doubtless  have  been  more  prompt.  At  his  death,  in  1830,  it  had  not 
yet  been  looked  upon  with  favor,  although  he  had  himself  performed 
it  thirteen  times  in  all,  with  at  least  eight  successes.  The  report  of  the 
first  three  cases  having  been  sent  to  Dr.  Phvsick  of  Philadelphia,  “the 
Father  of  American  Surgery,”  and  at  that  time  the  leader  of  the  Amer- 
ican profession,  it  failed  to  interest  him,  his  opinion  of  the  backwoods 
surgeon  being,  probably,  largely  influenced  by  the  display  of  his  literary 
ability.  The  report  was  also  sent  to  the  operator’s  old  preceptor,  .John 
Bell,  but,  owing  to  that  gentlemen’s  ill-health,  he  was  at  the  time  absent 
on  the  Continent,  and  as  he  died  not  long  afterward  at  Rome,  he  never 
received  it.  The  paper  fell  into  the  hands  of  Mr.  Lizars  of  Edinburgh, 
by  whom  it  was  published  in  the  Edinburgh  Medical  and  Surgical  Jour- 
nal in  1824.  Mr.  Lizars,  with  the  instinct  of  a true  surgeon,  detected 
its  merit,  and  was  the  first  to  perform  McDowell’s  operation  in  Great 
Britain.  This  recognition  of  the  Kentucky  surgeon  by  his  eminent 
Edinburgh  contemporary  won  for  the  prophet  and  his  operation  an 
honor  in  his  own  country  which  he  had  previously  been  denied. 

Dr.  McDowell  when  he  operated  on  Mrs.  Crawford  had  a reputation 
which  was  only  local,  or  he  was  at  least  known  within  but  compara- 
tively circumscribed  limits  from  his  own  home.  His  name  did  not 
appear  on  the  list  of  the  great  surgeons  of  his  day,  and — such  is  one 
of  the  peculiarities  of  human  nature — when  it  was  discovered  that  his 
claims  did  not  deserve  the  ridicule  with  which  they  were  greeted  even 
in  quarters  in  which  one  would  suppose  they  would  at  least  have 
received  respectful  attention,  if  not  indorsement,  envv  began  to  take 
the  place  of  ridicule.  Accordingly,  efforts  were  soon  made  to  i'ob  him 
of  the  honor  of  his  great  accomplishment,  and  claims  were  set  up  for 
a number  who  Avere  alleged  to  liave  pre\fiously  performed  the  operation. 

It  is  scarcely  necessary  in  this  place  to  review  the  nature  ot  these 
claims  or  to  discuss  their  validity.  Suffice  it  to  say  that  they  were  all 
carefully  investigated  by  the  late  Dr.  Samuel  D.  Gross,  and  by  him 
pronounced  untenable. 

While  the  operation  by  McDowell  marked  an  era  in  gynecology, 
two  years  before  he  performed  it  an  American,  Dr.  John  Stearns  ot 
Saratoga  county,  New  York,  had  given  to  medicine  the  drug  ergot, 
Avhich  Avas  destined  to  become  one  of  the  most  important  agents  in  both 


HISTORICAL  SKETCH  OF  AMERICAN  GYNECOLOGY.  27 

gynecology  and  midwifery.  It  is  true  the  drug  had  long  before  been 
empirically  employed  by  European  midwives,  but  Dr.  Stearns  was  the 
first  to  reclaim  it  from  such  unscientific  use  by  discovering  its  modus 
operandi.  The  publication  of  his  paper  in  the  New  York  Medical 
Repository  in  1807  at  once  gave  the  drug  a place  in  the  physician’s 
armamentarium,  and  its  judicious  employment  since  then  has  been  the 
means  of  relieving  perhaps  as  large  a percentage  of  woman’s  suffering 
as  any  one  surgical  procedure. 

The  next  in  chronological  order  to  McDowell  who  undertook  to 
remove  an  ovarian  tumor  in  this  country  was  Dr.  Nathan  Smith  of 
Yale,  who,  it  is  claimed,  was  not  at  the  time  aware  of  McDowell’s 
achievement.  His  first  operation  was  performed  on  July  5,  1821,  and 
was  successful,  the  patient  being  able  to  walk  about  in  three  weeks. 

On  May  23,  1823,  Dr.  Alban  G.  Smith  of  Danville,  Ivy.,  success- 
fully removed  an  ovarian  tumor  from  a negress  thirty  years  of  age. 
Dr.  Smith  had  made  a previous  but  unsuccessful  ovariotomy  in  1818. 
Following  this  last  successful  case  a number  of  unsuccessful  attempts 
were  made  by  other  surgeons,  who  in  cutting  down  to  the  tumor  found 
the  adhesions  so  extensive  as  to  deter  them  from  further  attempt  at 
removal  of  the  growth. 

The  fourth  successful  ovariotomist  of  this  country  was  Dr.  David  L. 
Rogers  of  New  York,  who  performed  the  operation  on  September  24, 
1829.  The  operation  lasted  two  hours,  and  at  the  end  of  two  weeks 
the  patient  was  able  to  be  up  and  about  her  room. 

In  November,  1830,  Dr.  J.  G.  Warren  of  Boston  made  an  unsuccess- 
ful attempt  at  the  removal  of  an  ovarian  tumor.  In  December,  1835, 
Dr.  J.  Billinger  performed  a successful  operation,  following  which  there 
are  no  records  of  any  cases  until  1843,  when  Dr.  A.  Dunlap  had  his 
first  case,  an  unsuccessful  one.  In  the  same  year  Dr.  J.  L.  Atlee  suc- 
cessfully performed  a double  ovariotomy.  In  1844,  Dr.  Washington 
L.  Atlee,  who  did  more  than  any  other  American  surgeon  to  establish 
ovariotomy  as  a legitimate  surgical  procedure,  had  his  first  case,  which 
terminated  unsuccessfully.  Dr.  Atlee  took  a decided  stand  in  favor  of 
the  legitimacy  of  the  operation,  and,  although  he  encountered  a number 
of  unsuccessful  cases,  he  faithfully  reported  them  in  detail  as  a guide  to 
those  who  might  be  induced  to  study  the  operation  with  a view  to 
removing  from  it  the  discoverable  reasons  for  its  mortality.  He 
encountered  violent  opposition  and  much  vituperation,  but  had  the 
satisfaction  of  living  to  witness  such  a general  recognition  of  ovariot- 
omy as  a legitimate  surgical  procedure  that  scarcely  any  surgeon  felt 
deterred  from  performing  it.  In  1855  he  published  a synopsis  of 
his  first  thirty  cases,  of  which  seventeen  recovered  and  thirteen  died. 
Such  a percentage  of  recoveries  from  a disease  in  itself  necessarily  fatal 
silenced  opposition  to  the  operation,  and  from  that  time  the  number 


28 


HISTORICAL  SKETCH  OF  AMERICAN  GYNECOLOGY. 


of  ovariotomists  in  this  country  has  rapidly  increased,  even  up  to  the 
present  time,  while  the  percentage  of  mortality  attending  the  operation 
by  competent  operators  has,  under  improved  methods,  antiseptic  and 
mechanical,  grown  to  be  quite  as  small  as  that  attending  most  other 
capital  operations. 

In  1853,  Dr.  Washington  L.  Atlee  read  before  the  American  Medi- 
cal Association  a paper  on  fibrous  tumors  of  the  uterus  which  at  once 
became  a portion  of  the  classic  gynecological  literature  of  this  country. 
It  dealt  with  such  of  these  tumors  as  had  heretofore  been  supposed  to  be 
inaccessible  to  the  knife  or  not  amenable  to  curative  measures.  The  paper 
was  based  wholly  on  the  author’s  own  experience,  and  gave  important 
information  touching  the  classification  and  means  of  diagnosing  these 
tumors,  besides  indicating  a method  of  their  treatment  bv  enucleation. 
It  divided  them  into — 1 , extra-uterine  or  surface  tumors  ; 2,  intra-ute- 
rine  or  cavity  tumors  ; and  3,  intramural  tumors  of  the  uterus.  The 
value  of  ergot  given  internally  as  a remedy  was  strongly  insisted  on, 
and  the  use  of  that  drug  in  the  removal  of  these  growths  through 
absorption  due  to  pressure  from  contraction  of  the  non-striated  muscu- 
lar tissue  has  since  been  regarded  as  the  most  efficacious  means  of  treat- 
ing such  growths  as  are  inaccessible  to  the  knife. 

In  1856  there  appeared  the  prize  essay  by  Dr.  George  H.  Lyman  of 
Boston  upon  the  History  and  Statistics  of  Ovariotomy , and  the  Circum- 
stances under  ivh ich  this  Operation  may  be  regarded  Safe  and  Expedient. 
Up  to  that  date  Dr.  Lyman’s  monograph  was,  probably,  the  most  com- 
plete of  any  that  had  appeared,  being  a complete  and  careful  research 
of  the  ovariotomy  statistics  of  all  countries. 

In  the  same  year  Dr.  I.  E.  Taylor  advocated  a new  operation  for  the 
cure  of  recto-vaginal  fistula,  reporting  two  cases  in  which  he  had  suc- 
cessfully employed  it.  This  operation  consisted  in  the  severing  of  the 
sphincter  ani  in  such  cases. 

Some  remarkable  operations  for  the  removal  of  the  extra-uterine 
foetus  were  performed  in  the  early  history  of  this  country.  In  1791, 
Dr.  William  Boynham  of  Virginia  successfully  removed  the  tumor  by 
incision  of  the  abdominal  parietes.  In  1799  he  performed  a similar 
operation,  and  with  equally  satisfactory  results.  In  1816,  Dr.  John 
King  of  South  Carolina  cut  through  the  walls  of  the  vagina  and 
removed  through  the  incision,  by  means  of  the  forceps  and  abdom- 
inal pressure,  a living  child  which  had  been  carried  through  the  full 
term  of  gestation  in  the  abdominal  cavity  outside  the  uterus.  The  life 
of  the  mother  was  also  saved.  This  case  stands  on  record  as  one  of  the 
most  remarkable  ever  encountered,  and,  being  without  precedent,  doe- 
all  the  greater  credit  to  the  operator’s  judgment  and  resolution.  In 
1874,  Dr.  T.  Gaillard  Thomas  incised  the  vaginal  wall  with  the  gal- 
vano-caustic  knife  and  removed  a three  months’  foetus;  and  in  1875, 


HISTORICAL  SKETCH  OF  AMERICAN  GYNECOLOGY. 


29 


Dr.  D.  Hayes  Agnew  of  Philadelphia  reported  a case  of  vaginal  section 
performed  by  himself  for  the  removal  of  an  extra-uterine  foetus. 

Simon’s  method  of  introducing  the  hand  into  the  rectum  for  diag- 
nostic and  therapeutic  purposes  is  not  as  new  as  many  are  disposed  to 
believe.  In  1806,  Dr.  Clark,  an  American,  recorded  the  fact  that  he 
introduced  his  hand  into  the  bowel,  and,  putting  his  finger  into  the 
mouth  of  an  extra-uterine  foetus,  made  traction  and  delivered  the  head 
per  rectum.  The  body  and  secundines  were  removed  spontaneously 
some  time  after.  On  the  next  day  the  anus  had  contracted  to  its  nat- 
ural size,  but  on  the  third  day  it,  as  well  as  the  perineum,  began  to 
slough.  On  the  ninth  day  the  parts  had  commenced  to  heal,  but  the 
fourchette  was  destroyed. 

Although  such  records  as  are  available  show  that  American  surgeons 
and  general  practitioners  were  quite  as  successful  in  their  treatment  of 
special  diseases  of  the  womb  as  were  their  contemporaries  abroad,  nearly 
half  a century  had  gone  by  since  McDowell’s  discovery  before  anything 
occurred  on  this  side  of  the  Atlantic  of  a nature  calculated  to  direct 
special  attention  to  American  gynecology.  But  the  native  shrewdness 
of  the  American  practitioner  qualified  him  for  such  utilization  of  exist- 
ing knowledge  as  made  him  the  peer  of  his  Transatlantic  brother  in 
this  special  direction.  Not  until  the  year  1852,  however — if  we  except 
Meigs’s  discovery  of  cardiac  thrombosis  as  a cause  of  sudden  death  in 
childbed,  and  Hodge’s  improvements  in  the  construction  of  uterine 
pessaries — did  any  of  the  great  Kentuckian’s  countrymen  do  aught 
worthy  of  giving  them  marked  distinction  in  the  direction  of  gvnecol- 
ogy.  Hodge’s  pessary  was  a very  decided  improvement  on  instruments 
heretofore  constructed  for  a similar  purpose,  being  based  on  more  cor- 
rect physiological  principles  than  any  of  its  predecessors.  The  descrip- 
tion of  the  steps  which  more  immediately  preceded  the  discoverv  of 
this  pessary  is  best  given  in  Dr.  Hodge’s  own  words,  as  quoted  in  a 
commemorative  address  by  Dr.  Penrose  of  Philadelphia : “ He  had 
been  contemplating  for  a long  time  the  subject  of  new  shapes  for  pes- 
saries, and  after  many  experiments  had  found  nothing  satisfactorv.  One 
evening  while  sitting  alone  in  the  room  where  the  meetings  of  the  med- 
ical faculty  of  the  university  were  held  his  eyes  rested  on  an  upright 
steel  support  bv  the  fireplace  designed  to  hold  the  shovel  and  tongs. 
The  shovel  and  tongs  were  kept  in  position  by  a steel  hook,  and  as  he 
surveyed  the  supporting  curve  of  this  hook  the  longed-for  lumination 
came : the  shape,  apparently  so  paradoxical,  revealed  itself  in  the  clear 
light  and  flickering  volume  of  the  burning  grate,  and  the  Hodge  lever 
pessary  was  the  result.”  This  was  in  the  year  1830.  To  him  the  pro- 
fession is  indebted  for  the  origin  and  development  of  two  ideas  which 
are  at  this  day  considered  among  the  most  important  facts  in  uterine 
pathology — namely,  that  the  condition  of  the  uterus  characterized  by 


30  HISTORICAL  SKETCH  OF  AMERICAN  GYNECOLOGY. 


enlargement,  displacement,  congestion,  hypersecretion,  and  tenderness  is 
not  inflammation,  nor  should  it  be  treated  as  such — that  sustaining  the 
uterus,  and  thus  affording  an  easy  and  natural  means  of  overcoming 
congestion  and  its  results,  is  a prime  factor  in  their  relief  and  cure. 

In  1833,  Dr.  Walter  Channing,  professor  of  obstetrics  at  Harvard 
University,  wrote  an  article  on  “ Irritable  Uterus.”  This  was  the  first 
comprehensive  monograph  upon  a purely  gynecological  subject  in  New 
England,  besides  being  one  of  the  most  valuable  contributions  extant 
to  this  division  of  medicine. 

In  1841,  Dr.  Gunning  S.  Bedford,  one  of  the  most  graceful  writers 
of  any  age,  established  the  first  clinic  for  diseases  of  women  ever  held 
on  this  side  the  Atlantic,  in  connection  with  his  chair  of  obstetrics  in 
the  University  Medical  College  of  New  York.  In  this  year  also  Dr. 
Alonzo  Clark  of  New  York  introduced  his  plan  of  treating  peritonitis 
with  large  doses  of  opium.  This  plan  involves  the  exhibition  of  the 
drug  to  the  limit  of  profound  narcotism.  The  amount  of  it  which  is 
tolerated  by  the  patient  is  greatly  in  excess  of  that  which  he  will  bear 
in  the  physiological  condition.  It  requires  the  close  attention  of  the 
physician  in  order  that  the  limit  be  not  inadvertently  exceeded. 

In  1844,  Dr.  J.  C.  Nott  of  Mobile,  Alabama,  published  a report  of 
a case  of  the  removal  of  a carious  coccyx,  which  was  followed  by  relief 
of  a very  aggravated  coccygodynia. 

During  the  year  1852  there  appeared  in  the  American  Journal  of 
Medical  Sciences  an  article  by  an  Alabama  doctor  which  once  more 
directed  the  eyes  of  the  medical  world  to  this  country.  If  Reeamier’s 
resurrection  of  the  speculum  marked  the  rise  of  modern  gynecology, 
this  article  caused  it  to  take  a stride  unprecedented.  Recamier’s  spec- 
ulum had  exposed  the  uterus,  but  it  did  so  quite  imperfectly,  and  was 
of  little  or  no  service  in  placing  the  vagina  under  surgical  control.  The 
writer  of  the  paper  referred  to  had  solved  the  problem,  and  the  surgical 
diseases  of  the  approach  to  the  womb  became  amenable  to  treatment, 
while  affections  of  the  womb  itself  ceased  very  largely  to  be  the  oppro- 
bria  of  the  healing  art.  If  McDowell’s  discovery  “ has  added  forty 
thousand  years  to  the  sum  of  human  life,”  who  can  compute  the  sum 
of  happiness  to  the  mind  and  misery  averted  through  this  discovery  by 
J.  Marion  Sims?  The  paper  by  him  on  vesico-vaginal  fistula  made 
his  title  of  “Father  of  American  Gynecology”  indisputable,  and  the 
discoverv  which  it  recorded  has  made  surgery  of  the  uterus  and  vagina 
a wellnigh  exact  science.  The  discovery  of  the  operation  for  the  cure 
of  a disease  previously  incurable  was  in  itself  a great  achievement,  but 
the  discovery  of  a method  of  so  distending  the  vagina  by  air  as  to 
render  this  operation  and  all  other  necessary  operations  on  the  vagina 
and  womb  possible  was  a greater  achievement.  Gynecology  to-day 
would  scarcely  deserve  the  name  of  a separate  branch  of  medicine  but 


HISTORICAL  SKETCH  OF  AMERICAN  GYNECOLOGY. 


31 


for  Sims’s  discovery.  It  has  been  appropriately  said  that  “ it  has  been 
to  diseases  of  the  womb  what  the  printing-press  is  to  civilization,  what 
the  compass  is  to  the  mariner,  what  steam  is  to  navigation,  what  the 
telescope  is  to  astronomy ; and  grander  than  the  telescope,  because  it 
was  the  work  of  one  man.” 

While  the  grand  results  to  gynecology  which  the  genius  of  Sims  has 
evolved  are  the  outcome  of  that  careful  study  and  constant  effort  which 
are  the  essentials  to  most  of  such  results  in  science  as  are  destined  to 
live,  the  discovery  of  the  fact  which  brought  his  mind  in  the  line  of 
work  which  made  him  famous  was  quite  purely  accidental.  Singular 
as  it  may  appear,  his  tastes  were  originally  not  for  gynecological  work : 
he  was,  indeed,  quite  averse  to  treating  diseases  of  the  female  sexual 
apparatus,  and  even  to  the  necessary  means  of  examination  for  making 
a diagnosis  of  such  affections.  He  had,  after  perhaps  more  than  the 
usual  share  of  vicissitudes  and  discouragements  which  beset  the  young 
practitioner,  and  extending  through  an  unusual  length  of  time,  suc- 
ceeded in  gaining  the  confidence  of  the  community  in  which  he  lived 
and  in  establishing  a reputation  as  a general  surgeon.  He  was  one  day 
called  in  consultation  in  a case  of  labor  in  which  the  head  had  been 
impacted  for  nearly  three  days.  He  delivered  the  woman  quite  readily 
with  the  forceps,  and  she  rallied  well  from  the  operation.  Five  days 
later  she  was,  however,  discovered  to  have  an  extensive  slough  of  the 
soft  parts,  and  was  discharging  both  urine  and  feces  through  the  vagina. 
He  had  then  been  in  practice  ten  years,  and  this  was  the  first  case  of 
vesico-vaginal  fistula  which  he  had  encountered.  After  consulting;  the 
literature  on  the  subject,  he  was  convinced  of  the  very  rebellious  nature 
of  the  accident  to  treatment,  and  in  spite  of  the  importunities  of  the 
owner  of  the  woman  (who  was  a slave),  he  refused  to  undertake  an 
operation  for  its  relief.  In  one  month  from  that  time  he  was  consulted 
in  reference  to  a vesico-vaginal  fistula  existing  in  the  case  of  another 
negro  slave,  and  again,  in  about  another  month,  a third  case  came 
under  his  notice.  This  unusual  number  of  cases  presenting  within 
such  a short  time  compelled  his  attention  to  the  disease,  and,  as  he  had 
established  a small  hospital,  the  three  cases  were  placed  under  his  care 
in  the  hope  that  he  might  devise  some  means  of  relief.  While  per- 
plexed with  these  cases  he  was  one  morning  suddenly  called  to  see  a 
lady  who  had  been  thrown  from  her  horse.  After  due  examination  he 
concluded  that  the  distressing  pain  from  which  the  woman  suffered  was 
caused  by  a dislocation  of  the  uterus.  Recalling  a rule  for  the  treat- 
ment of  this  accident  which  had  been  given  him  while  a student,  he 
placed  the  patient  on  her  knees  and  elbows,  and,  introducing  one  finger 
into  the  rectum  and  another  into  the  vagina,  “ pushed  up  and  pulled 
down”  according  to  directions.  Finding  that  he  could  just  reach  the 
uterus  with  his  index  finger,  which  was  not  long  enough  to  permit  him 


32  HISTORICAL  SKETCH  OF  AMERICAN  GYNECOLOGY. 


to  exert  any  force  on  the  organ,  he  introduced  also  the  middle  finger;  and 
in  his  effort  to  push  the  uterus  back  turned  his  hand  palm  upward  and 
then  downward,  when  all  at  once  he  could  feel  neither  the  womb  nor 
the  walls  of  the  vagina.  Immediately  the  woman  declared  she  was 
relieved.  As  she  turned  on  her  side  there  was  a sudden  explosion,  as 
though  of  air  escaping  from  the  bowel.  He  was  satisfied,  however, 
that  the  air  was  not  from  this  source,  but  was  from  the  vagina,  and 
concluded  that  his  traction  on  the  perineum  had  suddenly  created  a 
vacuum  into  which  the  air  rushed  and  expanded  the  vagina  to  its  fullest 
capacity.  Fired  with  a new  idea  which  had  just  been  forced  upon 
him,  he  hurried  home  in  order  to  test  it  in  the  case  of  the  unfortunates 
suffering  from  vesico-vaginal  fistula  in  his  hospital.  On  his  wav  he 
had  stopped  and  bought  a large  pewter  spoon,  which  he  bent  so  as  to 
secure  the  necessary  purchase  for  retracting  the  perineum,  as  he  had 
discovered  he  had  accidentally  done  in  the  case  of  the  woman  suffering 
from  the  dislocation  of  the  womb.  Selecting  one  of  his  patients,  he 
placed  her  on  a table  in  the  genu-pectoral  position,  and,  placing  a 
student  on  each  side,  instructed  them  to  lay  hold  of  the  nates  and  pull 
them  open.  Before  he  could  get  the  bent  spoon-handle  into  the  vagina 
the  air  rushed  in  with  a puffing  noise,  dilating  the  cavity  to  its  fullest 
extent.  On  making  further  traction  with  the  spoon  he  had  revealed 
to  him  a sight  which  had  never  before  been  seen  bv  anv  man.  The 
fistula  with  its  edges  clearly  defined  was  plainly  visible ; the  wall  of 
the  vagina  could  be  seen  closing  in  every  direction ; the  neck  of  the 
uterus  was  distinct  and  well  defined,  and  even  the  secretions  therefrom 
could  be  plainly  seen. 

He  at  once  devised  and  had  made  for  him  the  instruments  which  he 
considered  to  be  necessary  for  closing  up  the  fistula.  Among  these 
instruments  was  the  duck-bill  speculum,  to  which  his  name  has  been 
inseparably  attached ; and  it  is  a singular  fact  that  the  original  design 
of  that  instrument  has  never  been  altered.  It  took  him  three  months 
to  have  the  necessary  instruments  made,  and  the  case  which  he  selected 
for  the  operation  was  an  unusually  bad  one,  the  whole  base  of  the 
bladder  being  destroyed,  leaving  an  opening  between  the  vagina  and 
that  viscus  at  least  two  inches  in  diameter.  This  was  in  December, 
1845,  and  before  the  discovery  of  anaesthesia.  He  succeeded  in  clos- 
ing the  fistula  in  about  an  hour’s  time.  In  order  to  prevent  the  urine 
from  dripping  through  into  the  vagina,  he  placed  a piece  of  sponge  in 
the  neck  of  the  bladder,  through  which  he  ran  a silk  string  which 
he  hoped  would  act  as  a capillary  tube  that  would  serve  to  turn  the 
course  of  the  urine  from  the  fistula.  This  latter  device  proved  to  be 
a very  unfortunate  one.  At  the  end  of  five  days  the  patient  was  very 
ill  from  what,  in  more  recent  times,  has  come  to  be  known  as  blood- 
poisoning.  On  attempting  to  remove  the  sponge,  he  found  that  it  had 


HISTORICAL  SKETCH  OF  AMERICAN  GYNECOLOGY. 


33 


become  solidified  with  sabulous  matter  from  tlie  mine,  and  lie  bad 
great  difficulty  in  removing  it.  On  examining  the  fistula,  he  found 
that  it  had  disappeared  with  the  exception  of  two  small  openings  in 
the  line  of  the  union  of  its  edges.  Encouraged  by  this  pronounced 
success  in  healing  the  opening,  he  was  confident  that  the  small  remain- 
ing apertures  could  be  closed  bv  a subsequent  operation ; before  per- 
forming which,  however,  he  operated  on  another  of  his  patients,  using 
in  this  case  a self-retaining  catheter  instead  of  the  sponge.  At  the  end 
of  seven  days  he  removed  the  sutures,  but  discovered  that  though  the 
original  fistula  had  been  greatly  changed  in  character,  there  still 
remained  three  little  openings  through  which  the  urine  escaped.  In 
spite  of  the  repeated  operations,  having  Operated  some  thirty  times  on 
one  of  the  cases,  extending  through  a period  of  three  years,  he  found 
himself  unable  to  effect  a complete  closure  of  the  fistula  in  any  case. 
He  finally  concluded  that  he  should  not  perform  another  operation 
until  he  had  discovered  some  method  of  trying  the  suture  higher  up 
in  the  body  than  he  could  reach.  While  lying  in  bed  one  night  the 
idea  occurred  to  him  to  run  a perforated  shot  along  the  suture  to  the 
edge  of  the  fistula,  and  when  it  was  drawn  tight  to  compress  it  with  a 
pair  of  forceps,  thus  making  the  knot  perfectly  secure.  Elated  with 
this  idea,  he  conducted  further  operations,  but  with  scarcely  any  better 
success  than  heretofore.  He  was  now  convinced  that  the  cause  of  the 
failure  lay  in  the  nature  of  the  material  employed  for  sutures — namely, 
silk  thread — and  his  next  object  was  to  secure  some  substitute.  Mat- 
tauer  of  Virginia  had  employed  lead,  and  Sims  had  tried  this  material 
as  a suture  in  his  cases  of  vesico- vaginal  fistula,  and  had  failed.  At 
this  juncture,  in  walking  from  his  house  to  his  office  one  day,  he  picked 
up  a little  piece  of  wire.  Taking  this  to  a jeweller,  it  served  as  a pat- 
tern for  some  pure  silver  wire  which  he  ordered.  In  the  next  opera- 
tion the  edges  of  the  womb  were  denuded  and  brought  together  with 
four  sutures  of  wire  thus  prepared,  the  suture  being  closed  by  means 
of  the  shot  run  upon  the  wire  and  pressed  with  the  forceps  when  run 
sufficiently  far  up.  In  using  silk  sutures  cystitis  always  resulted  in 
the  case  of  operations  at  the  base  of  the  bladder,  the  urethra  being 
always  swollen  and  the  urine  loaded  with  thick,  ropy  mucus.  With 
the  use  of  the  silver  suture  there  was  a complete  change  in  these  con- 
ditions. After  a week  had  passed  the  patient  was  removed  from  the 
bed  and  placed  upon  an  operating-table,  and  with  an  anxious  heart 
the  result  of  the  use  of  the  wire  suture  was  examined.  There  lay  the 
suture  apparatus  just  exactly  as  it  had  been  placed,  with  no  inflam- 
mation, no  tumefaction,  and  perfect  union  of  the  fistula.  At  last  the 
labors  of  three  years  had  been  crowned  with  success,  and  vesico-vagi- 
nal  fistula  was  removed  from  the  list  of  incurable  affections.  In  the 
course  of  two  weeks  the  remaining  patients  in  the  hospital 

Vol.  I. — 3 


were 


34  HISTORICAL  SKETCH  OF  AMERICAN  GYNECOLOGY. 


operated  on,  and  in  every  case  the  results  were  completely  satis- 
factory. 

While  it  is  manifestly  the  duty  of  the  historian  to  select  for  his  nar- 
rative, without  bias  or  favor,  facts  which  he  regards  as  the  most  indis- 
putable, he  ought  not  to  be  accused  of  exceeding  his  duty  when  he 
notices  claims  which,  although  not  disposed  to  concede  them,  he  mav 
regard  as  entitled  to  respectful  consideration.  The  name  of  Sims  will 
live  in  the  history  of  medicine  as  that  of  the  father  of  American 
gynecology,  but  it  is  only  just  to  state  that  the  claims  of  priority  for 
some  at  least  of  the  achievements  which  have  won  him  this  proud 
title  have  been  disputed.  Among  those  who  have  contested  these 
claims,  his  contemporary,  Dr.  Nathan  Bozeman,  has  been  prominent. 
He  was  associated  with  Sims  in  the  early  years  of  their  practice,  and 
became  his  successor  at  Montgomery,  Alabama,  on  Sims’s  removal  to 
New  York.  Unfortunately,  a dispute  as  to  the  authorship  of  several 
of  the  devices,  which  have  made  the  operation  for  vesico-vaginal  fistula 
a success,  developed  in  later  years,  and  became  tainted  with  a consider- 
able degree  of  acrimony.  With  this  dispute  we  have  nothing  to  do, 
further  than  to  state  that  while  history  will  endorse  Sims’s  right  to  all 
that  he  claims  in  connection  with  the  discovery  and  perfection  of  the 
operation,  it  will  not  deny  to  Bozeman  an  important  part  in  helping 
to  establish  the  foundation  on  which  American  gynecology  is  erected. 
Dr.  Bozeman  subsequently  followed  Dr.  Sims  to  New  York.  Among  the 
discoveries  with  which  his  name  will  continue  to  be  associated  are  his 
knee-chest  support,  his  self-retaining  speculum,  his  button  sutures — 
instruments  and  methods  now  but  little  used ; also  his  method  of  auto- 
plasty  by  gradual  approaches,  and  his  operation  for  the  cure  of  chronic 
cystitis  through  the  establishment  of  a fistula  leading  into  the  vagina. 
This  operation  was  also  independently  discovered  in  the  same  year  by 
Dr.  T.  A.  Emmet,  who  was  the  first  to  give  it  to  the  profession  in  1868, 
Dr.  Bozeman’s  paper  not  having  been  published  until  1871. 

Dr.  Sims’s  achievements,  on  which  what  may  be  called  American 
gynecology  is  founded,  were  wrought  out  in  an  obscure  Southern  town 
and  while  engaged  in  the  commonplace  duties  of  the  country  general 
practitioner.  With  no  prestige  of  college  connection,  and  none  of  the 
backing  which  is  generally  considered  necessary  to  distinction  in  a spe- 
cialty, he  won  for  himself  the  proud  distinction,  “ Father  of  American 
Gynecology.”  It  was  necessary,  however,  after  having  thus  laid  this 
essential  foundation  that  it  should  become  known  to  the  profession. 
To  this  end  Dr.  Sims  determined  to  repair  to  one  of  the  medical 
centres,  and  this  the  precarious  state  of  his  health  compelled  him  to 
do  sooner  than  he  would  have  otherwise  done.  Being  the  victim 
of  a chronic  diarrhoea,  his  complaint  made  it  necessary  for  him  in 
1853  to  remove  from  the  scenes  of  his  distinguished  labors,  and  he 


HISTORICAL  SKETCH  OF  AMERICAN  GYNECOLOGY. 


35 


decided  on  New  York  as  his  future  home.  The  story  of  his  earlier 
years  in  that  city  furnishes  us  a singular  illustration  of  the  jealousy 
of  the  obscure  practitioner  on  the  part  of  the  gentlemen  connected  with 
the  medical  schools.  An  apparently  systematic  effort  was  made  to 
appropriate  his  work  without  credit,  and  the  attempts  of  certain  indi- 
viduals in  this  direction  reflect  little  credit  on  their  memory.  After 
encountering  opposition  and  suffering  discouragements  to  which  even 
he,  with  all  his  enthusiasm  and  force  of  character,  would  have  suc- 
cumbed but  for  the  support  and  cheer  of  an  heroic  wife,  he  was  thrown 
in  the  way  of  a Mr.  Henri  L.  Stuart,  who,  being  a man  of  great  influ- 
ence in  both  the  financial  and  social  world,  and  becoming  warmly  inter- 
ested in  the  object  of  Dr.  Sims’s  ambition — namely,  the  establishment 
of  a woman’s  hospital — entered  heartily  into  the  project.  At  Mr. 
Stuart’s  suggestion,  Dr.  Sims  sent  out  notices  to  the  general  profession 
that  he  would,  on  a certain  day  in  May,  1854,  deliver  a lecture  in  which 
he  would  call  the  attention  of  all  who  might  attend  to  the  work  which 
he  had  done.  In  view  of  the  treatment  which  he  had  received  at  the 
hands  of  the  gentlemen  on  whom  he  had  called  personally,  he  was  very 
much  encouraged  at  the  size  of  the  audience  which  had  responded  to  his 
invitation.  In  spite  of  his  innate  diffidence,  he  succeeded  in  not  only 
interesting  the  meeting,  but  in  arousing  it  to  a very  considerable  degree 
of  enthusiasm.  The  plan  of  establishing  a woman’s  hospital  was 
broached,  and,  largely  through  the  influence  of  Mr.  Stuart,  the  proj- 
ect found  favor  with  the  public,  and  many  prominent  ladies  of  the 
city  became  actively  interested  in  the  work.  These  ladies  formed 
themselves  into  an  association,  and  in  1855  the  object  of  Dr.  Sims’s 
ambition  was  realized — the  woman’s  hospital  had  become  a fact.  It 
received  very  little  encouragement  from  the  leaders ; that  is,  the  hospi- 
tal-men. Dr.  Sims  was  called  by  them  a quack  and  a humbug,  and 
the  hospital  was  pronounced  a fraud.  But  in  spite  of  the  formidable 
opposition  from  this  source  the  work  went  on,  the  wards  of  the  insti- 
tution were  opened  to  any  doctor  who  cared  to  come,  the  operations 
were  performed  in  the  presence  of  leading  medical  men,  and  the  pro- 
fession generally  was  welcomed  to  the  institution.  The  hospital  was 
inaugurated  on  the  1st  of  May,  1855,  at  83  Madison  Avenue,  shortly 
after  which  Dr.  Sims  associated  with  himself  Dr.  Thomas  Addis 
Emmet,  who  was  at  that  time  a young  man  and  unknown,  but  who 
has  since  won  for  himself  a reputation  in  gynecology  second  only  to 
that  of  Sims  himself.  The  woman’s  hospital  in  1857  secured  a charter 
from  the  State,  and  has  from  that  time  been  known  as  “ The  Woman’s 
Hospital  of  the  State  of  New  York.”  This  institution  has  been  the 
most  important  factor  in  the  progress  of  American  gynecology.  Here 
it  was  that  a systematic  method  of  treating  the  diseases  peculiar  to 
women  was  first  adopted.  Until  Sims’s  connection  with  it  gynecology 


36  HISTORICAL  SKETCH  OF  AMERICAN  GYNECOLOGY. 


as  a specialty  was  unknown,  he  being  the  first  to  give  attention  to  it,  to 
the  exclusion  of  all  affections  not  coming  distinctively  under  its  head. 
Under  his  direction  the  facilities  afforded  by  the  Woman’s  Hospital 
were  utilized  to  the  perfection  of  operations  on  the  perineum,  vagina, 
and  uterus,  which  previous  to  his  immortal  discoveries  had  been 
unknown,  but  which,  chiefly  through  the  knowledge  disseminated 
from  that  centre,  are  now  daily  performed  by  even  general  practitioners 
in  all  parts  of  the  world,  to  the  relief  of  untold  suffering. 

In  1861,  Dr.  Sims  visited  Europe.  His  reputation  had  preceded 
him,  and  his  reception  both  by  the  profession  and  the  public  was  in 
keeping,  and  he  soon  found  himself  with  such  a large  clientele,  in 
nearly  all  of  the  European  medical  centres  that  he  afterward  devoted 
his  time  about  equally  between  both  sides  of  the  Atlantic.  In  I860  he 
published  his  Clinical  Notes  on  Uterine  Surgery,  in  which  he  embodied 
the  results  of  his  special  work,  describing  the  operations  which  he  had 
devised  and  the  improvements  which  he  had  made  on  the  procedures 
hitherto  in  vogue.  This  work  made  a very  profound  impression  on 
the  professional  mind,  and  it  was  soon  translated  into  almost  all  mod- 
ern tongues.  It  was,  indeed,  the  most  distinctive  work  on  gynecology 
which  had  been  published,  and  may  be  said  to  be  the  basis  of  the  spe- 
cialty of  gynecology  as  it  exists  to-day.  Written  in  a style  calculated 
to  carry  conviction,  it  at  once  became  the  guide  and  gave  impetus  to 
gynecological  study. 

On  Dr.  Sims’s  retiracy  from  the  Woman’s  Hospital  in  1862,  Dr.  T. 
Addis  Emmet  became  surgeon-in-chief,  and  under  his  charge  the  insti- 
tution continued  to  grow  both  in  popularity  and  usefulness.  Following 
the  impetus  given  by  Sims  to  gynecology  as  a specialty,  a number  of 
American  surgeons  gave  their  attention  exclusively  to  this  branch  of 
work,  and  among  those  who  at  an  early  date  thus  devoted  themselves 
Thomas  Addis  Emmet,  H.  R.  Storer,  Nathan  Bozeman,  E.  R.  Peaslee, 
T.  Gaillard  Thomas,  James  P.  White,  W.  H.  Byford,  William  Goodell, 
and  Robert  Battey  have  attained  marked  distinction,  and  American 
gynecology  bears  the  indelible  marks  of  their  labors.  Some  of  these 
gentlemen  are  dead,  and  to  write  of  them  in  terms  of  the  enthusiasm 
which  their  valuable  work  naturally  arouses  in  a contemporary  who 
has  closely  watched  their  progress  might  be  in  keeping.  It  is,  how- 
ever, a delicate  and  very  difficult  task  to  write  of  the  living,  and  it  must 
remain  for  a future  historian  to  express  out  of  the  fulness  of  his  heart 
his  estimate  of  those  who,  having  done  their  life-work  in  this  direction, 
are  now  in  the  sere  and  yellow  leaf.  A bare  record  of  their  work  is  all 
that  is  now  permissible. 

Dr.  Emmet  in  1859  withdrew  from  general  practice,  and  lias  since 
devoted  himself  exclusively  to  gynecology.  He  has  been  a diligent 
worker  in  the  field,  and  has  contributed  freely  to  medical  periodicals 


HISTORICAL  SKETCH  OF  AMERICAN  GYNECOLOGY. 


37 


reports  of  the  results  he  has  achieved.  The  most  notable  of  his  con- 
tributions pertain  to  the  subject  of  laceration  of  the  cervix  uteri,  detail- 
ing the  etiology  of  the  affection,  its  symptoms,  its  effects  on  the  consti- 
tution, and  the  operation  for  its  relief.  This  operation  is  now  distinct- 
ively known  as  “ Emmet’s  operation.”  It  was  first  described  in  1869 
in  a paper  read  before  the  Medical  Society  of  the  County  of  New 
York,  and  published  in  the  February  number  (1869)  of  the  American 
Journal  of  Obstetrics.  In  1874  he  presented  before  the  same  society  an 
article  on  lacerations  of  the  cervix  uteri  as  a frequent  and  unrecognized 
cause  of  disease.  The  writer,  not  wishing  to  anticipate  the  events  of 
later  vears,  must  dismiss  this  subject  here,  but  will  allude  to  it  at  some 
length  when  writing  of  the  occurrences  of  the  last-mentioned  year. 

In  1854,  Dr.  E.  R.  Peaslee  made  a valuable  contribution  to  the 
treatment  of  septicaemia  following  ovariotomy.  His  method  consisted 
in  the  introduction  of  a tube  into  the  peritoneal  cavity,  through  which 
the  serous  sac  was  freely  washed  out.  Experience  with  this  new  method 
has  done  much  to  remove  the  fear  which  was  before  entertained  of  inter- 
ference with  the  peritoneal  membrane.  After  the  lapse  of  a third  of  a 
century  this  method  still  remains  as  the  most  reliable  for  the  treatment 
of  one  of  the  gravest  consequences  to  the  operation  for  the  removal  of 
ovarian  tumors.  In  one  of  Peaslee’s  cases,  reported  at  the  time  of  his 
introduction  of  this  new  method,  intraperitoneal  injections  were  kept 
up  for  fifty-nine  days,  and  in  another  for  seventy-eight  days,  recovery 
following  in  each  case. 

In  1856,  Sims  added  another  to  his  long  list  of  brilliant  achieve- 
ments bv  publishing  his  operation  for  narrowing  the  vagina  as  a means 
of  curing  prolapsus  of  the  uterus.  This  advice  was  not  strictly  original 
with  him,  although  we  have  no  evidence  to  show  that  he  had  imitated 
any  of  his  predecessors.  The  operation  had  been  performed  in  Europe 
many  years  previously,  but  had  fallen  into  desuetude. 

Dr.  James  P.  White  of  Buffalo  during  the  same  year  reported  the 
successful  reduction  by  taxis  of  an  inverted  uterus  of  eight  days’  stand- 
ing: Dr.  White  was  a pioneer  in  taking  the  position  that  chronic  inver- 
sion of  the  uterus  is,  as  a rule,  always  reducible.  He  is  distinguished  as 
the  first  successful  operator  in  the  country  to  reduce  a chronic  inverted 
uterus.  E.  Noeggerath  in  1862  practised  reduction  of  inverted  uterus 
by  digital  compression  of  both  horns;  and  in  1868,  Dr.  T.  Addis  Emmet 
reported  that  he  had  retained  partial  reposition  of  the  organ  by  closing 
the  os  externum  with  silver  sutures.  By  means  of  this  operation  the 
advance  made  at  one  sitting  is  not  lost,  and  the  case  is  thus  all  the 
better  prepared  for  future  effort. 

In  1861,  Sims  described  the  disease  known  as  vaginismus,  and  recom- 
mended, as  a means  for  its  relief,  the  removal  of  the  remains  of  the 
hymen  and  the  section  of  the  tissues  at  the  perineal  extremity  of  the 


38  HISTORICAL  SKETCH  OF  AMERICAN  GYNECOLOGY. 


ostium  vagi  me.  This  affection  had  been  previously  known  to  European 
authorities,  and  forcible  distension  of  the  ostiimi  vaginae,  together  with 
alterative  applications  with  a view  to  the  modification  of  the  local 
nervous  hypersesthesia,  recommended  for  its  relief.  The  operation  pro- 
posed by  Dr.  Sims  was,  however,  an  advance  on  the  latter. 

Prior  to  1862  but  one  case  of  pelvic  luematocele  had  been  published. 
In  this  year  this  subject  was  brought  prominently  to  the  notice  of  the 
profession  by  the  appearance  of  three  essays,  written  respectively  by 
John  Byrne  of  Brooklyn,  Fordyce  Barker  and  Emil  Xoeggerath  of 
New  York. 

In  1866  appeared  an  excellent  treatise  on  “ Vesico- vaginal  Fistula,” 
by  M.  Schuppert  of  New  Orleans.  It  contained  the  history  and 
exhaustive  summary  of  the  operation,  was  illustrated,  and  embodied 
the  extensive  experience  of  a successful  operator  in  this  department 
of  surgery. 

Dr.  Theophilus  Parvin  reported  in  1867  a case  of  uretro-vaginal 
fistula  in  which  he  operated  by  turning  the  displaced  distal  extremity 
of  the  ureter  into  the  bladder,  and  then  closing  the  vaginal  opening. 
The  operation  proved  entirely  successful,  and  tvas  original  with  Dr. 
Parvin. 

In  1869,  H.  R.  Storer  published  a “ Method  of  Exploring  and  Ope- 
rating upon  the  Female  Rectum  by  Eversion  of  the  Anterior  Rectal 
Wall  by  a Finger  in  the  Vagina.”  Since  then  this  “method”  has 
been  quite  generally  adopted  by  gynecologists  in  certain  cases. 

In  the  same  yearV.  A.  Taliaferro  of  Georgia  published  an  essay 
on  “ Pathological  Sympathies  of  the  Uterus,”  which  attracted  some 
attention. 

In  1869,  Dr.  Julius  F.  Miner  of  Buffalo  recommended,  as  an 
improvement  in  the  management  of  the  pedicle  after  the  removal  of 
an  ovarian  tumor,  the  stripping  off  from  the  tumor  the  expansion  of 
the  pedicle  instead  of  ligating  and  severing  it.  This  mode  of  treat- 
ing the  pedicle  was  called  by  Miner  “ enucleating  the  pedicle.”  This 
method  is  applicable  in  many  eases,  and  when  it  can  be  applied  is 
much  to  be  preferred  to  the  ordinary  methods  of  securing  the  pedicle 
by  clamp  or  ligature. 

In  1870,  Dr.  T.  Gaillard  Thomas  of  New  York  removed  an  ovarian 
cyst  of  the  size  of  a large  orange  through  an  opening  made  through  the 
vagina  and  the  cul-de-sac  of  Douglas.  This  was  the  first  time  that  this 
procedure  had  been  deliberately  adopted  for  this  purpose.  It  has  been 
successfully  practised  since  by  Dr.  Davis  of  Pennsylvania,  Dr.  Gilmour 
of  Alabama,  Dr.  Battey  of  Georgia,  and  others.  In  the  same  year  an 
important  contribution  to  the  current  gynecological  literature  appeared 
from  the  ready  pen  of  H.  R.  Storer  entitled  “ Anal  Fissure  in  Women." 
In  the  same  year  appeared  an  article  entitled  “ Sudden  Enlargement  of 


HISTORICAL  SKETCH  OF  AMERICAN  GYNECOLOGY. 


39 


Ovarian  Cysts  from  Hemorrhage  into  them,”  by  the  late  brilliant  and 
lamented  John  S.  Parry,  who  afterward  (1876)  wrote  so  learnedly  and 
exhaustively  on  “ Extra-uterine  Pregnancy.”  Dr.  F.  D.  Lente  has 
made  many  valuable -contributions  to  gynecological  literature,  his  prin- 
cipal article  being  “ Intra-uterine  Medication”  (1870),  of  which  he  was 
a prominent  advocate.  Lente’s  silver  probe  and  platinum  cup  were 
devised  for  the  purpose  of  applying  fusible  substances,  more  particu- 
larly nitrate  of  silver,  to  the  uterine  cavity.  His  method  was  a 
marked  improvement  upon  many  of  the  other  modes  ot  intra-uterine 
medication.  It  was  considered  very  valuable  when  caustics  were  more 
freely  and  more  frequently  used  within  the  cavity  ot  the  uterus  than  is 
customary  at  the  present  time. 

In  1871,  through  the  energetic  efforts  of  Dr.  A.  Reeves  Jackson,  the 
Woman’s  Hospital  of  the  State  of  Illinois  was  founded.  For  a number 
of  years  he  was  the  surgeon-in-chief,  but  latterly  a full  staff  of  medical 
officers  has  been  in  charge.  Dr.  M.  S.  Buttles  claims  to  have  been  the  first 
(1871)  to  apply  the  actual  cautery  to  the  uterine  cavity  in  the  treatment 
of  submucous  fibroids,  and  to  be,  therefore,  the  originator  of  that 
operation. 

In  1872,  Dr.  Robert  Battey  of  Atlanta,  Ga.,  reported  a case  of  extir- 
pation of  the  ovaries,  the  results  of  which  justified  him  in  recommend- 
ing this  operation  for  the  relief  of  dysmenorrhoea  due  to  imperfect 
ovulation  and  accompanied  by  an  excessive  menstrual  molimen,  the 
object  of  the  operation  being  to  establish  at  once  the  change  of  life,  and 
thus  prove  an  effectual  remedy  for  diseases  otherwise  incurable  and 
dependent  upon  ovarian  irritation.  He  termed  the  operation  “ normal 
ovariotomy.”  This  name  is  not  strictly  applicable,  inasmuch  as  it 
implies  a normal  condition  of  the  ovaries,  and  is  thus  nothing  more  or 
less  than  spaying — an  operation  which  has  been  practised  from  time 
immemorial  for  the  production  of  sterility.  The  important  points  con- 
nected with  this  subject  are  best  described  in  Dr.  Battey’s  own  words : 
“ I have  opei’ated  in  widely  different  circumstances.  In  one  case  the 
patient  had  amenorrhoea,  convulsions,  recurrent  hsematocele,  repeated 
pelvic  abscesses,  incipient  tuberculosis  from  pulmonary  congestion,  etc. 
Several  of  the  cases  passed  under  the  head  of  ovarian  neuralgia ; several 
had  intractable  dysmenorrhoea  with  pelvic  deposits  of  old  lymph  ; one 
had  ovarian  insanity,  etc.  All  had  exhausted  the  available  resources 
to  no  useful  purpose.  I operate  upon  no  case  that  any  other  respectable 
medical  man  proposes  to  cure.  In  most  of  my  cases  the  full  results 
of  the  operation  have  not  yet  been  developed.  This  is  the  work  of 
many  months,  and  sometimes  two  or  three  years  are  necessary  to  its 
full  and  perfect  realization.  In  no  case  has  the  patient  failed  to  realize 
such  a degree  of  relief  and  benefit  following  the  operation  as  to  amply 
compensate  her  for  the  pains  and  dangers  incident  thereto,  to  say 


40  HISTORICAL  SKETCH  OF  AMERICAN  GYNECOLOGY. 


nothing  of  the  promise  of  full  and  ample  recovery  at  the  completion  of 
the  physiological  change.  In  two  of  my  cases  this  change  has  seemed 
to  occur  at  once  in  all  its  completeness,  but  it  is  always  my  expectation 
that  it  will  occur  gradually,  extending  through  two  or  even  three  years 
to  its  tinal  completion.  In  my  first  case,  now  nearly  three  years  ago, 
the  restoration  to  health  is  eminently  satisfactory.  It  is  true  that  she 
is  not  absolutely  and  perfectly  well,  but  she  is  fully  relieved  of  the  con- 
vulsions, the  ovarian  periodical  congestions,  the  haematoceles,  the  pelvic 
abscesses,  etc.  for  which  I operated.  I submit  the  question  in  all  sin- 
cerity : If  I confine  myself  to  cases  where  life  is  in  danger  or  where 
health  and  happiness  are  destroyed- — -cases  which  are  utterly  hopeless 
of  other  remedy  this  side  of  the  grave — ought  the  profession  to  demand 
at  my  hands  the  restoration  of  these  forlorn  invalids  to  complete  and 
absolute  health  in  every  particular?” 

The  operation  was  originally  performed  by  Dr.  Battey  in  most  cases 
with  the  patient  on  the  left  side  and  by  the  aid  of  Sims’s  speculum. 
“ The  cervix  was  drawn  down  to  the  pubes  by  means  of  a strong  hook, 
where  it  was  held  while  Douglas’s  cul-de-sac  was  opened  from  the  vagina 
by  means  of  a pair  of  scissors.  On  reaching  the  ovary  with  the  finger 
as  a guide  it  was  seized  by  forceps  or  tenaculum  and  drawn  into  the 
vagina.  It  was  then  separated  by  the  ecraseur,  or,  being  secured  by 
a silk  ligature,  it  was  cut  off  and  the  stump  returned  into  the  cavity, 
the  opening  being  left  to  close  gradually,  so  as  to  admit  of  drainage.” 
Dr.  Battey  does  not,  however,  confine  himself  to  this  method  of  opera- 
tion, but  removes  the  ovaries  by  abdominal  section  as  well.  Battev’s 
operation  has  been  successfully  performed  by  a number  of  practitioners 
since  his  introduction  of  it,  and  a sufficient  time  has  now  elapsed  to 
permit  a just  estimate  of  its  merits ; and  there  no  longer  remains  any 
doubt  as  to  the  propriety  of  its  performance  in  cases  which  have  resisted 
all  other  means  of  treatment.  The  principal  danger  consists  in  it' 
performance  at  the  hands  of  unskilled  persons,  and  in  the  improper 
selection  of  cases,  which  is  very  apt  to  occur  in  the  practice  of  those 
of  limited  experience  in  the  treatment  of  diseases  peculiar  to  women. 
Dr.  Sims’s  inferences  from  his  experience  in  the  performance  of  the 
operation  are  as  follows,  and  they  are  generally  endorsed  by  those 
qualified  to  pass  an  opinion  : “ 1st.  Remove  both  ovaries  in  every  case; 
2d.  As  a rule  operate  by  abdominal  section,  because  if  the  ovaries  are 
bound  down  by  adhesions  it  is  possible  to  remove  them  entire,  whereas 
by  vaginal  incision  it  is  not  possible ; 3d.  If  we  are  sure  that  there  has 
been  no  pelvic  inflammation,  no  cellulitis,  no  hasmatocele,  no  adhesions 
of  the  ovaries  to  the  neighboring  parts,  then  the  operation  may  be  made 
through  the  vagina  or  otherwise.”  Dr.  Goodell  of  Philadelphia  formerly 
preferred  the  vaginal  method,  and  if  he  found  it  impossible  to  remove 
the  ovaries  in  that  direction  on  account  of  adhesions  or  other  causes,  he 


HISTORICAL  SKETCH  OF  AMERICAN  GYNECOLOGY. 


41 


would  resort  to  the  abdominal  section,  leaving  the  vaginal  incision  for 
deep  drainage.  The  timely  warning  of  the  experienced  gyneologist  who 
originated  it  must  never  be  forgotten  by  those  who  essay  the  procedure. 
Dr.  Emmet  would  limit  the  operation  to  the  extirpation  of  both  ovaries 
for  the  arrest  of  hemorrhage  from  a fibrous  tumor  and  in  cases  of  threat- 
ened insanity,  epilepsy,  or  phthisis.  1 or  nervous  disturbances  which 
present  more  of  the  hysterical  element  he  maintains  that  the  operation 
should  never  be  thought  of.  The  operation,  he  thinks,  may  be  more  fre- 
quentlv  necessary  in  the  present  generation  than  it  ought  to  be  in  the 
future,  since  a large  number  of  cases  calling  tor  it  have,  under  inju- 
dicious management,  been  already  rendered  incurable  by  other  means. 
He  holds  that  in  the  future  this  ought  not  to  be  so,  for  our  enlarged 
opportunities  for  acquiring  skill  in  the  treatment  ot  uterine  and  ovarian 
diseases  ought  to  enable  us  to  raise  our  patients  above  the  necessity  ot 
such  a terrible  ordeal.  This  operation  has  of  late  come  into  very  gen- 
eral use,  and  has  been  performed  by  many  operators  both  at  home  and 
abroad. 

During  the  year  1873  was  published  the  eminently  practical  treatise 
of  Dr.  D.  Haves  Agnew  of  Philadelphia  on  “ Laceration  of  the  Female 
Perineum  and  V esico- vaginal  Fistula,  History  and  Treatment.”  The 
profession  is  much  indebted  to  this  author  for  his  earnest  and  valuable 
labors  in  the  branches  of  surgery  of  which  this  volume  treats. 

In  the  year  above  mentioned  was  published  by  the  Government  a 
quarto  volume  entitled  A Report  of  the.  Columbia  Hospital  for  Women. 
This  was  written  by  Dr.  J.  H.  Thompson,  the  surgeon-in-chief  of  the 
hospital.  The  book  was  very  widely  distributed  throughout  the  coun- 
try. It  contains  much  valuable  matter,  but  it  encountered  a great  deal 
of  adverse  criticism  on  the  part  of  medical  editors  and  reviewers  fol- 
lowing its  publication. 

In  1873,  Dr.  John  Ball  of  Brooklyn  described  a plan  of  treating 
constrictions  and  irregularities  of  the  canal  of  the  cervix  uteri  from 
flexions  and  versions  by  rapid  dilatation  by  expanding  instruments  of 
steel.  His  method  is  to  first  evacuate  the  bowels  very  thoroughly,  so  as 
to  prevent  all  effort  in  that  direction  for  two  or  three  days.  The  patient 
is  then  placed  on  her  back  with  her  hips  near  the  edge  of  the  bed 
and  profoundly  anaesthetized.  A three-bladed,  self-retaining  speculum 
is  introduced  to  bring  the  os  uteri  into  full  view.  The  os  is  then 
seized  with  a double-hook  tenaculum  and  drawn  toward  the  vulva, 
when  an  ample  bougie,  as  large  as  the  canal  will  admit,  is  introduced, 
and  followed  in  rapid  succession  by  others  until  the  canal  is  dilated  to 
admit  of  a No.  7,  which  represents  the  size  of  his  dilator.  With  this 
instrument  the  cervix  is  stretched  in  every  direction  until  it  is  enlarged 
sufficiently  to  admit  of  a No.  16  bougie.  A hollow  gum-elastic  uterine 
pessary  of  that  size  is  then  introduced,  and  retained  in  position  by  a 


42  HISTORICAL  SKETCH  OF  AMERICAN  GYNECOLOGY. 


stem  secured  outside  of  the  vulva  for  about  a week,  in  which  time  it 
will  have  done  its  work  and  is  ready  to  be  removed.  The  patient  dur- 
ing this  time  is  kept  perfectly  quiet,  usually  upon  her  back,  which  is 
generally  found  to  be  the  most  comfortable  position.  Out  of  between 
twenty  and  thirty  cases  in  which  Dr.  Ball  had  to  resort  to  this  pro- 
cedure he  has  met  with  but  one  fatal  issue.  Lately,  Dr.  Goodell  of 
Philadelphia  has  published  a large  number  of  cases  operated  on  by 
forcible  divulsion  with  very  gratifying  results.  The  method  has  come 
into  very  general  use. 

Early  in  this  year  Emmet  published  an  account  of  the  cause  of  fail- 
ure and  a new  mode  of  operating  for  complete  laceration  of  the  peri- 
neum. Heretofore,  operators  had  not  taken  into  account  the  fact  that 
the  muscular  fibres  of  the  sphincter  retract  more  than  the  others.  Con- 
sequently, only  the  external  fibres  were  brought  together,  resulting 
often  in  entire  or  partial  failure  to  restore  the  retentive  powers  of  the 
anus,  and  frequently,  while  the  external  parts  would  be  united  and  the 
operator  thought  he  had  been  successful,  it  was  common  to  find  that  a fis- 
tula resulted.  By  diagrams  and  descriptions  he  showed  in  his  written 
articles  the  manner  in  which  the  denudation  must  be  made  and  sutures 
placed  in  order  to  secure  apposition  of  the  inner  as  well  as  the  outer 
fibres  of  the  sphincter : “ If  we  examine  carefully  the  extremities  of 
the  lacerated  muscle,  we  shall  find  a slight  pit  or  depression  at  each  end 
which  has  been  caused  by  contraction  of  a portion  of  its  fibres.  At  the 
commencement  of  the  operation  a portion  of  the  tissues  at  this  point 
must  be  seized  with  a tenaculum  and  removed  with  a pair  of  scissors, 
together  with  a narrow  strip  entirely  around  the  laceration  to  the  oppo- 
site end  of  the  muscle.  After  the  edges  of  the  muscles  have  been  prop- 
erly denuded  the  most  important  part  of  the  operation  is  to  introduce 
the  first  suture  in  its  proper  relation  to  the  edges  of  the  divided  muscle. 
The  manner  in  wdiich  these  sutures  should  be  introduced  can  only  be 
shown  by  diagrams,  and  is  not  essential  in  this  connection.  These 
sutures  are  so  adjusted  that  the  divided  edges  of  the  sphincter  are 
turned  up  and  appear  in  perfect  apposition.” 

But  he  also  taught  the  profession  the  importance  of  adjusting  the 
sutures  in  order  to  make  this  operation  a success ; and  as  a result  of 
the  teachings  of  this  distinguished  gynecologist  his  mode  of  operating  in 
these  cases  has  become  generally  known,  and  is  now"  the  common  prop- 
erty of  the  profession.  In  his  very  latest  writings  he  announces  that  he 
has  but  little  to  add  as  the  result  of  further  experience  to  the  paper 
which  was  published  during  this  year.  He  states  that  to  unravel  the 
cause  of  failure  in  this  operation  and  to  devise  means  of  obviating  it 
have  occupied  his  attention  for  many  years,  and  that  they  have  cost 
him  more  thought  than  he  has  ever  devoted  to  any  other  pi’ofessional 
subject. 


HISTORICAL  SKETCH  OF  AMERICAN  GYNECOLOGY. 


43 


In  1873  also  Dr.  Thomas  M.  Drysdale  of  Philadelphia  described  a 
peculiar  corpuscle  as  characteristic  of  ovarian  fluid,  and  for  a time  it 
was  believed  that  a perfect  means  of  diagnosis  of  the  existence  of  cystic 
ovarian  tumors  by  microscopical  examination  of  their  contents  could 
be  determined ; but  while  Dr.  Drysdale  seems  to  have  been  very  suc- 
cessful in  diagnosticating  ovarian  tumors,  others  have  not  been  so  suc- 
cessful. The  late  Dr.  Atlee  attached  great  importance  to  this  method 
of  Dr.  Drysdale’ s,  whose  views  upon  this  matter  may  be  summed  up  in 
the  following  words  : “ I claim,  then,  that  a granular  cell  has  been  dis- 
covered by  me  in  ovarian  fluid  which  differs  in  its  behavior  with  acetic 
acid  and  ether  from  any  other  known  granular  cell  found  in  the  abdom- 
inal cavity,  and  which  by  means  of  these  reagents  can  be  readily  recog- 
nized as  the  cell  which  has  been  described ; and  further,  that  by  the 
use  of  the  microscope  and  assisted  by  these  tests  we  may  distinguish 
the  fluid  removed  from  ovarian  cysts  from  other  abdominal  dropsical 
fluids.” 

In  this  same  year  (1873)  a paper  which  has  been  designated  as  a 
remarkable  one,  and  which  excited  much  adverse  criticism,  was  pub- 
lished by  Joseph  R.  Beck  of  Indiana,  entitled  “ How  did  the  Sperma- 
tozoa Enter  the  Uterus  ?”  The  patient  of  the  doctor  in  whom  sexual 
orgasm  could  be  produced  by  digital  examination  was  the  subject  upon 
whom  his  observations  were  made,  which  are  reported  as  follows  : “ The 
cervix  uteri  had  been  firm,  hard,  and  generally  in  a normal  condition, 
with  the  os  closed  so  as  not  to  admit  the  uterine  probe  without  difficulty ; 
but  immediately  the  os  opened  to  the  extent  of  fully  an  inch,  made  five 
or  six  successive  gasps,  drawing  the  external  os  into  the  cervix  each 
time  powerfully,  and  at  the  same  time  becoming  quite  soft  to  the  touch. 
All  these  phenomena  occurred  within  the  space  of  twelve  seconds’  time 
certainly,  and  in  an  instant  all  was  as  before — the  os  was  closed,  the 
cervix  hardened,  and  the  relation  of  the  parts  had  become  as  before  the 
orgasm.”  According  to  Flint,  Jr.,  Sitzmann  of  Germany  published 
similar  observations  in  1846. 

In  1874  one  of  the  most  important  contributions  to  the  pathology 
and  treatment  of  diseases  of  the  neck  of  the  uterus  was  published  by 
Dr.  T.  Addis  Emmet.  It  had  long  been  known  that  childbirth  caused 
lacerations  of  the  muscular  portion  of  the  neck  of  the  uterus,  but  pre- 
vious to  his  description  no  one  had  seemed  to  recognize  how  uniformly 
such  lacerations  had  been  confounded  with  so-called  ulceration  of  the  neck 
of  the  uterus,  or  how  commonly  the  ectropion  at  the  neck  of  the  lip 
resulting  from  such  tears  had  been  mistaken  for  hypertrophy  of  the 
tissues.  Emmet,  recognizing  these  conditions,  began  to  devise  some 
method  for  their  cure,  and  he  advocated  for  this  condition  the  paring 
of  the  edges  of  the  ulcerated  part  and  the  bringing  of  them  together 
by  means  of  sutures. 


44 


HISTORICAL  SKETCH  OF  AMERICAN  GYNECOLOGY. 


The  mode  of  operating,  as  first  laid  down  by  Emmet,  is  to  place  the 
patient  on  the  left  side  in  the  Sims  position,  and  by  means  of  a Sim- 
speculum  bring  the  parts  into  view.  The  first  step  is  to  bring  the  flaps 
together  in  apposition,  and  while  they  are  lifted  up  by  means  of  a double 
tenaculum  in  the  hands  of  an  assistant  a uterine  tourniquet  is  slipped 
over  the  cervix  below  the  point  of  vaginal  junction,  and  tightened, 
the  object  of  this  being  to  control  hemorrhage  during  the  operation. 
The  surfaces  of  the  laceration  are  then  freshened  either  with  scissors 
or  scalpel,  after  which  they  are  brought  together  by  means  of  silver 
sutures.  One  of  the  essentials  to  the  success  of  the  operation  consists 
in  the  complete  removal  of  cicatricial  or  other  adventitious  tissue  during 
the  freshening  of  the  parts. 

Since  the  introduction  of  Emmet’s  operation  and  the  publication 
by  its  author  of  the  technique  of  the  operation,  other  gynecologists 
have  adopted  different  means  to  accomplish  the  same  results.  The 
uterine  tourniquet  is  not  deemed  requisite  to  control  hemorrhage,  nor 
is  it  the  universal  custom  to  place  the  patient  in  either  the  left  or  right 
semi-prone  position.  It  is  no  longer  deemed  a prerequisite  to  success 
that  silver  wire  must  be  invariably  used,  or  that  no  other  speculum 
than  Sims’s  will  suffice.  Hot  water  will  control  hemorrhage.  The 
dorsal — or,  more  commonly,  the  exaggerated  lithotomy  position,  or 
the  position  of  Simon — is  chosen  by  many.  Silk,  or  catgut  properly 
prepared,  is  more  easily  introduced  than  silver,  and  is  less  liable  to 
cut  tissues.  The  silkworm-gut  suture  is  preferred  by  some.  Some 
of  those  who  have  used  Simon’s  speculum  a number  of  times  prefer 
it  to  Sims’s.  This  procedure  is  now  generally  known  as  “ Emmet’s 
operation.”  It  is  the  belief  of  most  American  gynecologists — in 
which  the  writer  fully  concurs — that  this  operation  marks  one  of  the 
greatest  advances  in  modern  gynecology.  At  the  same  time,  it  is  an 
operation  which  is  liable  to  many  and  great  abuses.  Owing  to  the  fact 
that  so  many  neurasthenic  women,  as  well  as  those  suffering  from  neur- 
algias from  the  imprisonment  of  nervules  in  the  cicatricial  tissue  of  the 
torn  uterine  neck,  have  been  relieved  by  this  operation,  many  superficial 
observers  have  resorted  to  it  wfith  such  frequency  as  to  often  bring  it  into 
disrepute.  Many  of  our  foreign  brethren  have  also  attempted  to  ridi- 
cule the  operation,  but,  in  spite  of  all,  the  fact  still  remains  that  no  one 
operation  or  procedure  of  equal  importance  for  the  relief  of  suffering 
women  has  been  devised  in  the  last  quarter  of  a century. 

In  March  of  this  same  year  (1874)  Emmet,  during  an  operation  for 
a submucous  fibroid  tumor  of  the  uterus,  discovered  the  value  of  trac- 
tion during  enucleation  in  producing  a denuded  pedicle.  His  mode 
of  operating  was  with  scissors  around  the  base  of  the  tumor,  and  to  his 
surprise  the  raw  surface  thus  left  seemed  much  smaller  than  the  orig- 
inal base  of  the  tumor.  The  value  of  traction  was  several  years  before 


HISTORICAL  SKETCH  OF  AMERICAN  GYNECOLOGY. 


45 


insisted  upon  by  him,  but  not  until  March,  1874,  was  he  able  to 
demonstrate  clearly  that  the  attenuated  pedicle  was  the  effect  of  the 
traction,  and  not  an  accident.  In  a case  operated  upon  at  that  time  he 
was  able  to  encircle  the  broad  basis  of  the  tumor  with  his  fingers  and 
feel  the  process  of  pedunculation  going  on,  as  strong  contraction  was 
produced  by  traction,  the  contraction  beginning  at  the  fundus  and  run- 
ning down  in  an  oblique  direction.  On  this  account  the  traction  should 
be  made  as  near  the  fundus  as  possible.  In  this  case  a base  of  three 
inches  in  diameter  became  a pedicle  of  the  size  of  a common  lead-pencil, 
and  the  point  of  attachment  after  removal  was  reduced  to  a small  pit, 
thus  leaving  an  almost  infinitesimal  surface,  comparatively  speaking, 
for  the  possible  absorption  of  septic  matter. 

In  the  year  1874  there  were  two  papers  in  the  Boston  Medical  Jour- 
nal upon  pelvic  drainage  after  ovariotomy,  by  Dr.  Gilman  Kimball  of 
Lowell,  Mass.,  a distinguished  pioneer  in  ovariotomy.  Dr.  Montrose 
A.  Pallen  of  N ew  York  published  a description  of  the  operation  as  a 
substitute  for  amputation  of  the  neck  of  the  uterus  in  certain  forms  of 
intravaginal  elongation,  which  he  termed  vaginal  cervi  plasti. 

In  the  same  year  Dr.  Marion  Sims  contributed  a valuable  paper  to 
the  New  York  Medical  Journal  upon  the  enucleation  of  intra-uterine 
fibroids. 

In  this  year  also  appeared  a small  work,  written  in  a powerful  stvle 
by  Dr.  Edward  H.  Clark  of  Boston,  entitled  Sex  in  Education.  No 
work  upon  medical  topics  or  any  kindred  subject  in  modern  times  suc- 
ceeded better  in  attracting  the  attention  of  the  people  for  whose  benefit 
it  was  written  to  the  influence  of  the  habits  of  modern  life  on  the 
sexual  organs. 

In  1875  a valuable  and  interesting  paper  appeared  by  Dr.  J.  R. 
Chadwick  of  Boston  in  the  American  Journal  of  Obstetrics  upon  injec- 
tion of  nutritious  or  cathartic  fluid  into  the  intestines  through  the 
abdominal  walls  by  means  of  an  aspirator  needle  when  the  stomach 
proves  entirely  intolerant. 

In  this  year  Dr.  Xoeggerath  of  Xew  York  published  in  the  Ameri- 
can Journal  of  Obstetrics  an  interesting  paper  upon  “ Yesico- vaginal 
and  V esico-rectal  Touch — a New  Method  of  Examining;  the  Uterus 
and  Appendages.” 

In  the  Transactions  for  1875  of  the  American  Medical  Association 
is  a paper  by  Dr.  Byford  of  Chicago  upon  “ The  Treatment  of  Uterine 
Fibroids  bv  Ergot.”  This  method,  for  the  purpose  of  causing  atrophy 
ot  uterine  fibroids,  was  first  suggested  by  Hiklebrandt,  but  Byford  seems 
to  have  been  tire  first  to  advocate  the  use  of  this  remedy  in  sufficiently 
large  doses  to  cause  expulsion  in  addition  to  the  atrophy. 

In  this  same  year  was  published  a valuable  and  very  interesting 
paper  by  Dr.  H.  F.  Campbell  of  Georgia  upon  “ Position,  Pneumatic 


46 


HISTORICAL  SKETCH  OF  AMERICAN  GYNECOLOGY. 


Pressure,  and  Mechanical  Appliance  in  Uterine  Displacements.”  This 
gentleman  has  from  time  to  time  written  several  papers  bearing  upon 
the  same  subject.  He  advocated  replacement  of  uteri,  if  posteriorly 
displaced,  by  the  patient  assuming  the  knee-chest  position,  and  the 
introduction  of  a glass  tube  into  the  vagina  while  this  position  is 
maintained.  This  position,  by  favoring  the  gravitation  of  the  viscera 
forward,  together  with  the  introduction  of  air  into  the  vagina  through 
the  glass  tube,  will  often  effect  reposition  of  the  displaced  organ. 

In  this  same  year  an  interesting  paper  was  contributed  to  the  Rich- 
mond and  Louisville  Medical  Journal  by  Dr.  Goodman  of  Louisville 
upon  “ Menstruation  and  the  Law  of  Monthly  Periodicity.”  Dr. 
Brickell  of  Hew  Orleans  contributed  also  an  article  upon  “ Rupture 
of  the  Perineum,  with  a Description  of  a Hew  Operation.” 

In  1875,  Alexander  Skene  of  Brooklyn  performed  the  operation  of 
laparo-ely trotomy,  with  a result  never  before  attained.  The  patient  was 
a dwarf  with  a rachitic  pelvis,  who  had  been  three  times  delivered — 
twice  by  premature  delivery  and  once  by  craniotomy.  In  her  fourth 
pregnancy  Dr.  Skene  allowed  it  to  advance  to  the  full  term,  and  then, 
after  labor  had  begun,  he  performed  the  operation,  saving  the  mother, 
and  a healthy  child  of  ten  pounds’  weight.  This  operation  might  more 
properly  be  designated  as  one  pertaining  to  obstetrics,  and  yet  we  cannot 
forbear  alluding  to  it  here.  It  is  one  that  had  attracted  the  attention 
of  obstetricians  in  our  own  country  and  in  Europe  at  different  times, 
and  had  been  essayed  by  Skene  in  1874,  but  first  by  T.  Gaillard 
Thomas  in  1870,  who  states  that  he  did  it  without  a knowledge  of  the 
fact  that  he  been  anticipated  in  the  procedure  by  Baudeloque.  In  Dr. 
Thomas’s  case  the  patient  died  in  one  hour,  and  the  child,  premature 
and  imperfectly  developed,  also  almost  simultaneously. 

The  year  1876,  being  termed  the  “Centennial  year,”  as  it  was  the 
year  in  which  this  country  celebrated  its  hundredth  anniversary  as  an 
independent  nation,  was  rich  in  gynecological  work.  It  also  marks 
the  beginning  of  a very  important  epoch  in  American  gynecology — 
namely,  the  formation  of  the  American  Gynecological  Society.  In 
response  to  a summons  issued  May  24th  a number  of  gynecologists 
from  various  parts  of  the  United  States  came  together  at  the  hall  of 
the  Academy  of  Medicine  in  the  city  of  Hew  York  for  the  purpose  of 
forming  a society  for  the  advancement  of  the  special  department  of 
medicine  in  which  they  were  chiefly  interested.  The  meeting  was 
called  to  order  by  Dr.  Chadwick  of  Boston,  who  had  taken  the  most 
active  part  in  the  formation  of  the  society,  and  was  organized  by  the 
election  of  Dr.  E.  R.  Peaslee  of  Hew  York  as  chairman  and  Dr. 
Chadwick  as  clerk.  Remarks  was  made  by  Dr.  Peaslee  upon  the 
importance  of  such  a society,  and  by  Dr.  Chadwick,  who  said  that 
“ the  call  to  which  you  have  responded  by  your  presence  here  to-day 


HISTORICAL  SKETCH  OF  AMERICAN  GYNECOLOGY. 


47 


was  addressed  to  a limited  number  of  recognized  gynecologists  after 
consultation  with  several  of  the  prominent  men  of  Boston,  New  York, 
Philadelphia,  and  the  West.  It  was  not  intended  to  include  all  those 
whose  labors  in  this  field  of  medicine  would  fully  entitle  them  to  an 
honored  place  in  our  ranks,  but  simply  to  form  a nucleus  around  which 
gynecologists  of  the  country  should  cluster.  It  seems  a most  fitting 
tribute  to  our  national  greatness  that  those  who  have  striven  to  advance 
the  noble  cause  of  humanity,  of  science,  of  art  in  any  of  their  depart- 
ments should  take  steps  in  this  Centennial  year  to  prosecute  their  labors 
in  the  coming  century  with  renewed  vigor  and  under  more  favorable 
circumstances.”  These  remarks  apply  with  more  than  common  force 
to  the  branch  of  medicine  in  which  America  can  justly  claim  to  stand 
pre-eminent.  There  were  at  this  inaugural  meeting  the  following  gen- 
tlemen : Drs.  Fordyce  Barker,  E.  R.  Peaslee,  T.  A.  Emmet,  T.  G. 
Thomas,  J.  M.  Sims,  I.  E.  Taylor,  E.  Noeggerath,  W.  T.  Lusk,  P. 
F.  Munde,  of  New  York  ; John  Byrne,  A.  J.  C.  Skene,  of  Brooklyn ; 
A.  D.  Sinclair,  G.  H.  Bixby,  J.  R.  Chadwick,  of  Boston ; W.  Goodell 
of  Philadelphia  ; J.  D.  Trask  of  Astoria,  N.  Y. ; T.  Parvin  of  Indian- 
apolis; W.  H.  Byford  of  Chicago;  and  Ed.  W.  Jenks  of  Detroit,  Mich. 

Letters  were  read  from  Drs.  D.  H.  Storer,  C.  E.  Buckingham,  G. 
H.  Lyman,  W.  L.  Richardson,  of  Boston ; W.  L.  Atlee,  R.  A.  F. 
Penrose,  E.  Wallace,  A.  H.  Smith,  T.  M.  Drysdale,  J.  V.  Ingham, 
of  Philadelphia;  S.  C.  Busey  of  Washington;  E.  Van  de  Warker 
of  Syracuse ; J.  P.  White,  of  Buffalo ; R.  Battey,  of  Rome,  Ga. ; 
J.  C.  Reeve,  of  Dayton,  O. ; and  G.  J.  Engelmann,  of  St.  Louis.  On 
motion  these  gentlemen  were  added  to  the  list  of  Fellows',  and  were 
considered  as  founders  of  the  society. 

A committee  consisting  of  Drs.  Trask,  Sinclair,  Jenks,  Noeggerath, 
and  Lusk  was  appointed  by  the  chair  to  nominate  a list  of  officers  for 
the  first  annual  meeting.  The  following  list  of  officers  was  reported, 
and  the  gentlemen  unanimously  elected : President,  Fordyce  Barker ; 
A ice-Presidents,  A\ . L.  Atlee,  TV . H.  Byford  ; Council,  J.  M.  Sims,  W. 
Goodell,  T.  Parvin,  G.  H.  Lyman;  Secretary,  J.  R.  Chadwick  ; Treas- 
urer, P.  F.  Munde. 

The  first  annual  meeting  ol  the  society  was  held  in  the  same  place 
Sept.  13,  14,  and  15,  1876,  at  which  twenty-eight  Fellows  were  pres- 
ent. This  society  has  since  its  organization,  although  not  numbering 
among  its  Fellows  all  of  the  able  gynecologists  of  our  country,  really 
represented  the  progress  of  American  gynecology.  Its  annual  volumes 
ol  Transactions  have  shown  the  rapid  progress  made  in  this  specialty, 
and  have  given  evidence  of  much  original  work,  and  each  year  its  list 
ol  Fellows  has  been  augmented  by  the  election  of  new  members,  and, 
although  many  of  its  founders  have  passed  away,  the  character  of  the 
society’s  work  has  continued  to  be  of  the  highest. 


48 


HISTORICAL  SKETCH  OF  AM  ERIC  AH  GYNECOLOGY. 


Dr.  Lyman  of  Boston  published  a paper  on  the  theory  entitled  “ A 
Theory  of  the  Cause  of  Menorrhagia/’  with  a list  of  cases  treated  with 
success  by  dilatation,  which  reads  substantially  as  follows  : “ Dilatation 
of  the  cervix  for  surgical  and  diagnostic  purposes  is  an  old  procedure, 
but  that  it  should  be  followed  by  arrest  of  hemorrhage,  although 
observed  by  some,  was  not  publicly  noticed  until  1869  by  Dr.  Sims.” 
In  1876,  Dr.  Lyman  of  Boston  reported  a short  list  of  eases  in  which 
he  had  used  dilatation  with  success  in  menorrhagia,  and  advanced  the 
following  theory  : “ In  menorrhagia  there  is  constriction  of  the  vessels 
at  the  internal  os,  giving  rise  to  congestion  of  the  tissues  above : such 
constriction  doubtless  is  due  to  some  morbid  condition  beneath  the 
mucous  membrane.  Hence  this  operation  is  beneficial,  although  the 
opening  through  the  canal  be  apparently  sufficiently  large.  Precaution 
is  to  be  taken  that  the  hemorrhage  is  not  due  to  malignant  disease,  and 
that  there  is  no  cellulitis  nor  peritonitis.” 

In  this  same  year  a valuable  paper  was  published  by  Dr.  Skene  on 
the  principles  of  gynecology  as  applied  to  obstetrical  operations. 
Although  not  wholly  original  or  the  first  time  that  many  of  his 
theories  were  enunciated,  it  is  well  worthy  of  mention  in  a history 
of  American  gynecology.  Dr.  Skene  advocated  the  use  of  Sims’s 
speculum  in  performing  craniotomy  and  in  using  the  cephalotribe, 
perforation  being  recommended  to  precede  the  use  of  that  instrument. 
The  use  of  Sims’s  speculum  also  facilitates  the  carrying  out  of  Thom- 
as’s method  of  replacing  a prolapsed  cord ; also  the  introduction  of 
Barnes’s  dilators.  He  also  recommended  the  use  of  the  speculum  in 
applying  the  tampon  for  arrest  of  hemorrhage  and  in  the  use  of  the 
curette  or  the  scoop  in  removing  the  ovum. 

In  1876,  also,  Dr.  Xoeggerath  of  Hew  York  read  a paper  at  the 
American  Gynecological  Society  upon  latent  gonorrhoea,  especially  with 
regard  to  its  influence  on  fertility  in  woman.  This  was  his  first  paper 
in  the  English  language  upon  the  subject,  as  the  one  in  1872  was  pub- 
lished in  the  German  language  in  Bonn.  This  paper  has  given  rise  to 
much  discussion,  favorable  and  unfavorable,  and  frequent  allusion  to  it 
has  been  made  in  home  and  foreign  journals.  The  paper  and  the 
author’s  conclusions  are  certainly  unique,  and  we  cannot  forbear  to 
allude  to  the  latter,  which  he  summarizes  as  follows : 

“ 1st.  Gonorrhoea  in  the  male,  as  well  as  in  the  female,  persists  for 
life  in  certain  sections  of  the  organs  of  generation,  notwithstanding  its 
apparent  cure  in  many  instances. 

“ 2d.  There  is  a form  of  gonorrhoea  which  may  be  called  latent  gon- 
orrhoea, in  the  male  as  well  as  the  female. 

“ 3d.  Latent  gonorrhoea  in  the  male,  as  well  as  in  the  female,  may 
infect  a healthy  person  either  with  acute  gonorrhoea  or  gleet. 

“ 4th.  Latent  gonorrhoea  in  the  female,  either  the  consequence  of  an 


HISTORICAL  SKETCH  OF  AMERICAN  GYNECOLOGY. 


49 


acute  gonorrhoeal  invasion  or  not,  if  it  passes  from  the  latent  into  the 
apparent  condition  manifests  itself  as  acute,  chronic,  recurrent  peri- 
metritis or  ovaritis,  or  catarrh  of  certain  sections  of  the  genital  organs. 

“ 5th.  Latent  gonorrhoea  in  becoming  apparent  in  the  male  does  so 
by  attacks  of  gleet  or  epididymitis. 

“ 6th.  About  90  per  cent,  of  sterile  women  are  married  to  husbands  who 
have  suffered  from  gonorrhoea,  previously  to  or  during  married  life.” 

In  1876,  Dr.  Jenks  of  Detroit  published  the  result  of  his  observa- 
tions  on  the  use  of  Viburnum  prunifolium  in  the  treatment  ot  diseases 
of  women.  This  remedy  had  a limited  use  for  some  years  as  a preven- 
tive of  abortion,  it  having  been  first  introduced  by  Dr.  Phares  ot  Mis- 
sissippi. The  writer  advocated  the  use  of  this  remedy  in  all  forms  of 
dysmenorrhcea  attended  with  profuse  menstruation.  It  is  not  sufficiently 
sedative,  if  given  alone,  to  fully  relieve  the  sufferings  of  spasmodic 
dysmenorrhcea.  It  is,  however,  a valuable  adjuvant  to  sedative  and 
antispasmodic  remedies.  In  dysmenorrhcea  with  menorrhagia  caused 
by  fibroid  growths  viburnum,  in  combination  with  ergot,  has  proved 
much  more  valuable  than  either  remedy  given  without  the  other.  The 
writer  gave,  as  a general  statement  concerning  the  uses  of  viburnum, 
“ that  it  is  serviceable  in  all  uterine  disorders  characterized  by  loss  of 
blood.”  Since  Dr.  Jenks’s  paper  was  published  the  remedy  has  come 
into  more  general  use,  and  the  results  have  shown  that  too  much  Avas 
not  said  in  its  praise. 

In  this  year  also  the  first  ten  cases  of  Battey’s  operation  by  Dr. 
Battey  Avere  published,  the  folloAving  results  being  claimed  for  the 
operation  in  the  cases  reported : Complete  relief,  3 ; temporary  relief,  2 ; 
life  prolonged,  1 ; no  benefit,  2 ; death,  2. 

In  the  same  year  there  AA'as  published  by  Henry  C.  Lea  of  Philadel- 
phia a small  volume  entitled  A Century  of  American  Medicine,  Dr.  T. 
G.  Thomas  contributing  the  chapter  on  obstetrics  and  gynecology.  No 
one  except  those  Avho  have  had  occasion  to  search  through  the  A'olumes 
and  periodicals  for  historical  matter  can  fully  appreciate  the  labor 
Avhich  such  an  able  paper  must  haA’e  cost  its  author.  It  contains  a 
summary  of  everything  of  importance  that  had  been  previously  done 
in  these  departments  by  the  profession  of  this  country. 

In  1877  a paper  Avas  published  by  Dr.  Brickell  of  XeAV  Orleans  on 
the  diagnosis  and  treatment  of  pehdc  effusions.  Three  cases  are 
reported  by  Dr.  George  H.  Bixbv,  one  by  Dr.  Byforcl,  treated  bA' 
aspiration  either  through  the  abdominal  Avails  or  per  vaginam,  the 
latter  site  being  preferred.  The  history  of  these  cases  is  aM  liable  as 
showing  the  progress  in  the  diagnosis  of  pelvic  effusions  and  the  relief 
afforded  by  this  mode  of  treatment.  Dr.  Brickell  considers  the  remoA'al 
of  a collection  of  serum  in  the  cellular  tissue  as  necessary  as  the  removal 
of  a collection  of  pus. 

Vol.  I.— 4 


50  HISTORICAL  SKETCH  OF  AMERICAN  GYNECOLOGY. 


A paper  was  read  before  the  American  Gynecological  Society  by  Dr. 
Goodell  on  the  subject  of  vaginal  ovariotomy.  This  operation  was 
first  performed  by  Washington  L.  Atlee,  but  the  first  premeditated 
vaginal  ovariotomy  was,  as  previously  stated,  performed  by  Dr.  T.  G. 
Thomas  in  1870.  Dr.  Goodell,  in  discussing  the  subject,  concludes 
that  while  this  operation  can  never  rival  the  ordinarv  operation,  it  is 
preferable  in  rare  cases — namely,  where  a small  polycyst  lodges  in 
Douglas’s  pouch  or  an  unadherent  monocyst  protrudes  into  the  pelvic 
cavity.  The  difficulties  met  with  in  this  operation  are  from  prolapsus 
of  the  intestines  and  unforeseen  adhesions.  In  this  same  vear  Dr.  Paul 
F.  Munde  made  a valuable  report  on  the  treatment  of  ovarian  tumors 
by  electrolysis.  Dr.  Yon  Ehrenstein  claims  to  be  the  originator  of  this 
method,  and,  although  this  claim  is  disputed,  he  has  at  least  had  a 
larger  experience  than  any  other  in  its  use.  It  was  brought  more 
prominently  into  notice  by  an  announcement  in  1875  of  Dr.  Semelleder 
of  Mexico.  Dr.  Munde,  from  his  own  experience  and  that  of  others, 
draws  the  following  conclusions  regarding  the  operation : That  this 
method  is  most  apt  to  be  beneficial  in  cases  where  the  tumor  is  mono- 
cystic,  and  yet  so  small  as  not  to  demand  the  radical  operation  ; or  a 
poly  cyst  with  thin  walls  and  fluid  contents,  and  absence  of  large  and 
solid  masses ; or  a large  unilocular  or  multilocular  tumor,  in  which 
adhesions  are  so  extensive  as  to  render  ovariotomy  dangerous. 

Although  it  has  long  been  known  that  mental  aberrations  may  be 
caused  by  the  sexual  disturbance  occurring  at  the  time  of  puberty, 
menopause,  during  pregnancy,  the  puerperal  state,  and  lactation,  the 
idea  of  connecting  this  abnormal  mental  state  with  disease  of  a non- 
gravid  uterus  is  modern.  The  first  in  this  country  to  call  attention  to 
the  causative  relations  of  uterine  and  ovarian  disease  to  mental  dis- 
turbances in  women  were  Dr.  Fordyce  Barker  of  New  York  and  Dr. 
H.  R.  Storer  of  Boston.  The  former  published  an  article  upon  this 
subject  in  1872,  and  the  latter  a monograph  upon  the  same  subject  in 
1871,  while  both  had  promulgated  their  ideas  by  lectures  some  years 
previously. 

In  1877,  Dr.  George  J.  Engelmann  made  a valuable  collection  of 
facts  concerning  hystero-neurosis.  These  show  that  neuroses  of  the 
brain,  pharynx,  -larynx,  eye,  stomach,  intestines,  bronchii.  and  joints 
of  severe  and  misleading  character  are  frequently  produced  by  non- 
development or  disease  of  the  uterus  or  ovaries,  or  both,  or  by  peri- 
uterine disease.  That  the  apparent  disease  of  the  organs  named  was  a 
neurosis  was  proved  by  its  disappearance  upon  removal  of  the  abnor- 
mal condition  of  the  uterus. 

In  1878  there  appeared  a paper  on  the  causes  of  vesico- vaginal  fis- 
tula bv  Dr.  T.  A.  Emmet,  in  which  he  exonerated  the  forceps  from 
the  charge  that  has  been  laid  to  them  of  frequently  causing  such  lesions, 


HISTORICAL  SKETCH  OF  AMERICAN  GYNECOLOGY. 


51 


and  attributed  the  frequency  of  fistula  rather  to  delay  in  delivery  and 
the  neglect  to  use  the  catheter  before  instrumental  delivery. 

In  this  same  year  appeared  in  the  New  York  Medical  Journal  a very 
valuable  contribution  from  the  facile  pen  of  Dr.  T.  G.  Thomas  on  the 
most  effectual  method  for  controlling  the  high  temperature  occurring 
during  ovariotomy.  Dr.  Thomas’s  method  is  as  follows  : Upon  a 
Kibbee  fever-cot  a folded  blanket  is  laid,  so  as  to  protect  the  patient’s 
bodv  from  cutting  by  the  cords  of  the  netting.  At  one  end  is  placed 
a pillow  covered  with  india-rubber  cloth,  and  a folded  sheet  is  laid 
across  the  middle  of  the  cot  to  about  two-thirds  of  its  extent.  Upon 
this  the  patient  is  now  laid : her  clothing  is  lifted  up  to  the  armpits 
and  the  body  enveloped  by  the  folded  sheet,  which  extends  from  the 
axil  he  to  a little  below  the  trochanters.  The  legs  are  covered  by  flan- 
nel drawers  and  the  feet  by  warm  woollen  stockings,  and  against  the 
soles  of  the  latter  bottles  of  warm  water  are  applied.  Two  blankets 
are  then  placed  over  the  patient  and  the  application  of  water  is  made. 
Turning  the  blankets  down  below  the  pelvis,  the  physician  now  takes  a 
large  pitcher  of  water  at  from  70°  to  80°  F.,  and  pours  it  gently  over  the 
sheet.  This  it  saturates,  and,  percolating  the  network  of  the  cot,  it  is 
caught  by  the  india-rubber  cloth  beneath,  and,  running  down  the  gutter 
formed  by  this,  is  received  in  a tub  placed  at  its  extremity  for  that  pur- 
pose. Water  at  a higher  or  lower  temperature  than  this  may  be  used. 
As  a rule,  it  is  better  to  begin  with  a high  temperature,  85°  to  90°,  and 
gradually  diminish  it.  The  patient  now  lies  in  a thoroughly  soaked  sheet 
with  warm  bottles  to  her  feet,  and  is  covered  up  carefully  with  dry  blank- 
ets. Neither  the  portion  of  the  thorax  above  the  shoulders  nor  the  infe- 
rior extremities  are  wet  at  all.  The  water  is  applied  only  to  the  trunk. 
The  first  effect  of  the  affusion  is  to  elevate  the  temperature,  but  the 
next,  when  the  application  is  practised  for  an  hour,  usually  brings  it 
down.  The  water  collected  in  the  tub  at  the  foot  of  the  bed,  having- 
passed  over  the  body,  is  usually  eight  or  ten  degrees  warmer  than 
when  poured  from  the  pitcher.  This  mode  of  procedure  has  been 
modified  by  others,  but  still  it  is  to  Dr.  Thomas  that  we  are  indebted 
for  this  effective  means  of  reducing  the  temperature. 

In  this  same  year  Dr.  E.  Van  de  Varker  of  Syracuse,  N.  Y.,  con- 
tributed a valuable  paper  containing  some  original  opinions  upon  the 
treatment  of  adhesions  and  indurations.  The  objects  of  treatment  in 
this  case  are — 1st,  to  allay  pain  : 2d,  to  produce  absorption.  For  the 
first  object  anodynes — namely,  opium  or  opium  combined  with  Vibur- 
num prunifolium — are  valuable.  More  important,  however,  though  act- 
ing less  quickly,  are  rest,  postural  treatment,  hot  fomentations,  and  an 
occasional  blister.  Swinging  in  a hammock  admirably 1 combines  a 
soothing  feeling,  from  the  gentle  motion,  with  relaxation  of  the  abdom- 
inal muscles  and  elevation  of  the  hips.  The  continuous  current,  ten 


52  HISTORICAL  SKETCH  OF  AMERICAN  GYNECOLOGY. 


to  sixteen  cells,  indirectly  through  the  system  and  through  the  indura- 
tion, is  also  important.  The  agents  for  producing  absorption  are  less 
direct,  but  still  more  valuable — viz.  the  galvanic  current  directlv 
through  the  mass,  one  electrode  being  placed  in  the  vagina  and  one  on 
the  abdomen.  The  internal  use  of  ammonium  chloride  markedly  less- 
ens the  size  of  the  mass,  producing  absorption,  probably  by  its  effect 
upon  the  portal  circulation.  Careful  handling  at  a later  stage  not  only 
hastens  absorption,  but  also  tends  to  reduce  the  tenderness.  The  best 
method  is  by  bimanual  manipulation,  a gentle  to-and-fro  motion  given 
the  mass  by  rolling  it  between  the  hands,  one  of  which  is  placed  against 
the  vaginal  and  the  other  against  the  abdominal  side.  If  the  mass  ls 
situated  in  the  iliac  fossa,  then  the  bone  affords  sufficient  internal  sup- 
port, and  but  one  hand  is  used. 

In  1878,  Dr.  Henry  J.  Bigelow  of  Boston  reported  a number  of 
cases  operated  upon  by  a method  which  he  had  devised  for  crush- 
ing and  removing  the  fragments  of  stone  in  the  male  bladder.  He 
demonstrated  that  tolerance  by  the  bladder  of  protracted  manipula- 
tion is  greater  than  heretofore  recognized,  and  that  the  operation  of 
lithotrity  can  be  done  at  one  sitting.  The  article  of  Dr.  Bigelow  is  of 
great  importance,  and  even  more  applicable  to  the  female  bladder  when 
no  cystitis  or  thickening  exists. 

In  1879,  Dr.  Edward  W.  Jenks  of  Detroit  published,  in  the  Amer- 
ican Journal  of  Obstetrics,  a paper  upon  perineorrhaphy,  in  which  he 
described  a method  devised  bv  himself  for  denuding  the  mucous  sur- 
faces with  but  little  loss  of  blood.  His  method,  given  in  his  own 
words,  is  as  follows  : 

“ The  patient  being  etherized,  I begin  by  cutting  with  a scissors  the 
anterior  margin  of  surface  to  be  denuded  at  the  juncture  of  integument 
and  mucous  membrane.  Next  I introduce  two  fingers  of  the  left  hand 
into  the  rectum,  while  assistants  hold  the  labia  apart,  it  being  important 
that  they  are  held  uniformly  tense.  I use  scissors  slightly  curved  and 
sharp-pointed  to  denude  the  mucous  membrane.  I use  neither  tenacu- 
lum nor  tissue-forceps,  but  with  the  parts  tense  snip  a hole  in  the 
mucous  membrane  in  the  median  line  close  to  the  integument,  and 
then,  inserting  the  scissors  with  a cutting  motion  into  the  small  hole 
made,  I continue  to  dissect  the  mucous  membrane  away  from  adjacent 
tissues  without  removing  the  scissors,  first  going  up  the  septum  as  far 
as  desired,  and  then  laterally,  first  on  one  side  and  then  on  the  other, 
without  removing  the  scissors  or  once  bringing  their  points  out  from 
beneath  the  mucous  membrane.  Then  with  blunt-pointed  scissors  I 
cut  away  the  dissected  flaps.  The  advantages  of  this  method  are — a, 
the  rapidity  with  which  it  can  be  done ; b,  the  absence  of  hemorrhage 
in  the  vagina,  as  no  blood  escapes  at  the  locality  where  the  scissors  enter 
beneath  the  mucous  membrane  ; c,  the  ability  with  which  the  operator 


HISTORICAL  SKETCH  OF  AMERICAN  GYNECOLOGY. 


53 


ran  make  complete  denudation,  as  the  discoloration  beneath  the  mucous 
membrane  marks  the  route  the  scissors  have  taken.  This  mode  of 
operating  is  only  applicable  where  there  is  redundancy  of  the  tissues, 
and  not  where  there  has  been  g'reat  loss  ol  substance,  as  in  cases  where 
the  septum  has  been  torn  to  any  great  extent.” 

The  same  author  describes  also  in  the  same  paper  a new  method  of 
securing  the  sutures  in  the  operation  of  kolpo-perineorrhaphy. 

In  this  same  year  there  was  a valuable  contribution  on  the  subject 
of  ovarian  diseases  made  by  Dr.  Mund6,  entitled  “ Prolapsus  of  the 
Ovaries.”  In  this  paper  he  gave  points  in  diagnosis  and  modes  of 
treatment.  Mention,  however,  had  been  made  of  this  subject  in  the 
Journal  of  the  Gynecological  Society  of  Boston  in  1872  by  Storer, 
Warner,  and  Blake.  In  this  publication,  covering  the  results  of  his 
observations,  Munde  calls  attention  to  the  fact  that  uncongested  ovaries 
may  become  prolapsed,  and  in  turn  prolapsus  leads  to  congestion.  He 
calls  attention  to  points  now  well  known,  that  many  of  these  cases  were 
undetected,  and  directs  attention  to  the  physical  and  mental  derange- 
ments to  which  they  lead.  He  also  directs  attention  to  the  value  of 
the  genu-pectoral  position  and  Sims’s  speculum  as  aids  in  their  replace- 
ment. In  the  discussion  which  followed  this  paper,  which  was  read 
before  the  American  Gynecological  Society,  Dr.  Barker  recommended 
suppositories  of  iodide  of  lead  if  painting  the  vaginal  roof  with  iodine 
produced  too  much  irritation.  Drs.  Bozeman  and  Munde  had  found 
iodoform  useful  in  these  cases  for  the  relief  of  the  hypenesthesia.  Dr. 
Albert  H.  Smith  advised  examination  by  rectum  for  diagnostic  pur- 
poses, and  Dr.  Skene  alluded  to  the  pain  during  and  after  defecation  as 
a diagnostic  symptom.  Dr.  Taliaferro  of  Atlanta,  Ga.,  was  the  first  to 
suggest  packing  the  vagina  with  cotton  tampons  to  support  prolapsed 
ovaries.  In  April,  1878,  Dr.  Taliaferro,  in  a paper  read  before  the 
Medical  Association  of  Georgia,  advocated  pressure  by  the  tampon  as  a 
therapeutic  in  the  treatment  of  uterine  and  periuterine  diseases. 

In  1880  a paper  was  written  by  Dr.  Chadwick  advocating  the  use 
of  hot  rectal  douches  in  the  treatment  of  pelvic  inflammations. 

At  the  meeting  of  the  American  Gynecological  Society  in  1880, 
C.  D.  Palmer  of  Cincinnati  read  a full  and  instructive  paper  entitled 
“ Laparotomy  and  Laparo-hysterotomy,  their  Indication  and  Statistics 
for  Fibroid  Tumors  of  the  Uterus.” 

In  this  year  also  a paper  was  read  by  Dr.  A.  Reeves  Jackson  of 
Chicago,  at  a meeting  of  the  American  Gynecological  Society,  on 
“ Uterine  Massage  ” as  a means  of  treating  certain  forms  of  enlarge- 
ment  of  the  womb,  which,  although  not  wholly  original  with  the  writer, 
gave  rise  to  some  considerable  discussion  in  home  and  foreign  medical 
journals. 

In  1881  an  interesting  paper  was  published  by  Dr.  Van  de  Warker 


54  HISTORICAL  SKETCH  OF  AMERICAN  GYNECOLOGY. 


in  which  he  recommends  forcible  elongation  of  pelvic  adhesions  in  cases 
where  they  cause  pain  during  defecation  or  other  straining  efforts. 

In  this  year  Dr.  Thomas  published  a paper  upon  “ Laparotomy  com- 
plicated by  Expansion  of  the  Bladder  over  the  Surface  of  Abdominal 
Tumors,  and  its  Attachment  to  them  or  to  the  Abdominal  Walls.”  He 
made  a collection  of  reports  and  cases,  and  offered  the  following  mode 
of  procedure : “As  diagnosis  even  by  the  sound  is  difficult,  if  it  is  not 
impossible,  this  complication  is  not  perceived  until  the  abdominal 
incision  is  made  or  the  bladder  laid  open.  If  it  happens  to  be 
attached  to  the  abdominal  parietes,  the  bladder  should  be  separated 
by  digital  detachment.  If  adhesion  is  too  close,  then  incise  the  ante- 
rior wall  of  the  bladder ; if  incision  has  not  already  been  made,  with 
two  fingers  in  the  bladder  as  a guide  the  adhesions  can  be  cut.  Then 
clamp  the  edges  of  incision  between  the  lips  of  the  abdominal  wound, 
and  close  by  silver  sutures.” 

An  interesting  paper  by  Dr.  William  Goodell  of  Philadelphia  was 
published  on  “ Bursting  Cysts  of  the  Abdomen,”  in  which  the  author 
alludes  to  the  great  difference,  as  far  as  danger  is  concerned,  between 
parovarian  and  ovarian  cysts,  the  contents  of  the  former  usually  being 
limpid  and  innocuous,  and  the  fluid  eliminated  frequently  bv  the  kid- 
neys, intestines,  or  skin,  and  is  usually  rapidly  taken  out.  In  case  of 
the  bursting  of  ovarian  cysts  the  danger  is  much  greater.  He  alludes 
to  a case  seen  by  Dr.  Sims  in  1856  which  burst  three  times,  the  fluid 
being  eliminated  by  each  of  the  three  channels  mentioned — one  entirely 
by  the  kidneys,  another  entirely  by  the  intestines,  and  the  remaining 
one  wholly  by  the  skin. 

In  1882,  Dr.  Emmet  brought  to  the  notice  of  the  profession  his  new 
method  of  exploration  and  treatment  of  the  urethra  by  the  “ butt<  >n- 
hole  incision,”  as  he  designates  it.  He  first  essayed  this  method  in 
1879.  It  consists  of  a buttonhole  incision  in  the  urethra  extending 
from  near  the  meatus  to  a short  distance  from  the  neck  of  the  bladder, 
the  greatest  length  being  on  the  vaginal  mucous  membrane.  Retention 
is  not  impaired,  and  diagnosis  and  treatment  are  greatly  facilitated.  The 
special  advantage  of  this  method  is  the  facility  which  it  offers  to  the 
diagnosis  and  treatment  of  polypi  or  other  growths  about  the  neck  of 
the  bladder.  After  the  cure  is  effected  the  opening  is  easily  closed. 

In  this  year  Dr.  J.  C.  Warren  of  Boston  offered  a new  method  of 
operation  for  laceration  of  the  perineum  involving  the  sphincter  and 
rectal  wall.  The  operation  consists  in  dissecting  a butterfly  flap  from  the 
posterior  vaginal  wall  above  the  rent,  and  a similar  flap  from  above  down- 
ward, leaving  plenty  of  attachment  around  the  entire  edge  of  the  rup- 
tured rectal  wall  and  sphincter.  The  flap  is  turned  downward,  cover- 
ing the  rectal  rent.  The  freshened  edges  of  the  sphincter  are  brought 
together  over  the  flap,  which  hangs  out  of  the  anus  like  a small  liemor- 


HISTORICAL  SKETCH  OF  AMERICAN  GYNECOLOGY.  55 

rhoicl.  All  freshened  surfaces  are  then  brought  in  coaptation,  the  flap 
being  laid  in  folds.  The  part  hanging  from  the  anus  if  not  too  long 
will  draw  up  as  cicatrization  takes  place. 

In  January  of  this  year  Dr.  Christian  Fenger  of  Chicago  recorded 
the  first  successful  operation  of  kolpo-hysterectomy  for  uterine  cancer, 
at  which  time  he  also  advocated  the  operation  as  a justifiable  one.  Dr. 
O.  Stroiusky  of  Chicago  in  this  year  reported  a novel  operation  for 
traumatic  rupture  of  the  bladder : while  removing  a fibroid  polypus 
from  the  bladder  by  twisting  he  made  a rent  into  the  anterior  Avail, 
inverted  the  whole  bladder  through  the  dilated  urethra,  repaired  the 
rent  by  three  sutures,  and  replaced  the  bladder.  The  result  Avas 
recovery. 

In  1883,  Dr.  C.  C.  Lee  read  before  the  American  Gynecological 
Society  a paper  on  the  injuries  of  the  gravid  uterus  as  a complication 
of  laparotomy.  From  a study  of  a necessarily  small  collection  of  cases 
both  at  home  and  abroad,  the  first  occurring  in  1856,  Dr.  Lee  con- 
cludes that — 1st,  the  gravid  uterus  may  be  Avounded  Avithout  neces- 
sarily producing  abortion  ; 2d,  abortion  seems  to  depend  upon  opening 
the  ovisac ; 3d,  if  the  uterine  contents  are  injured  Caesarean  section  is 
indicated,  after  Avhieh  drainage  may  be  maintained  through  the  dilated 
cervix  ; 4th,  if  the  uterine  contents  are  uninjured,  the  wound  is  to  be 
treated  on  general  principles — namely,  exact  coaptation  by  carbolized 
sutures. 

In  this  year,  too,  Emmet  describes  a new  operation  for  so-called 
laceration  of  the  perineum.  It  is  considered  particularly  useful  where 
there  are  large  rectoceles.  In  this  paper  he  holds  that  the  loss  of  sup- 
port following  the  laceration  produced  by  childbirth  is  not  due  to  the 
injury  of  the  perineal  body.  In  fact,  he  denies  the  existence  of  any 
such  body,  and  claims  that  the  injury  is  due  rather  to  the  detachment 
of  perineal  muscles  and  the  perineal  fascia.  The  description  of  this 
operation  by  the  author  is  by  no  means  lucid,  but  it  substantially  con- 
sists in  a semilunar  form  of  denudation,  wholly  within  the  A'agina, 
of  such  extent  that  AA’lien  the  edges  are  brought  together  by  means 
of  sutures  the  “ slack  ” in  the  posterior  Avail  is  entirely  taken  up  or 
made  to  disappear,  and  yet  the  ostium  vaginae  is  in  no  way  denuded  or 
directly  interfered  Avith.  The  advantages  claimed  are — great  diminu- 
tion in  the  discomfort  folloAving  immediately  after  the  operation,  and 
the  perfect  juxtaposition  of  the  anterior  and  posterior  vaginal  Avails,  as 
in  the  non-parous  Avoman. 

In  the  Transactions  of  the  American  Gynecological  Society  for  1883 
appears  a paper  by  Dr.  E.  W.  Jenks  describing  a new  mode  for  operat- 
ing for  fistula  in  ano.  In  the  same  volume  is  a paper  of  Dr.  Emmet’s, 
in  which  he  alludes  to  having  performed  the  operation  in  the  same 
manner,  neither  gentleman  having  been  aAvare  of  the  fact  that  the  other 


56 


HISTORICAL  SKETCH  OF  AMERICAN  GYNECOLOGY. 


had  performed  the  operation.  Dr.  -Jenks’s  first  operation  was  on  March 
31,  1881.  The  operation  consists  in  incising  the  fistulous  tracts  after 
the  usual  method,  dissecting  out  the  so-called  pyogenic  membrane  and 
all  lardaceous  and  cartilaginous  substances  along  the  route  of  the  fistula, 
and  also  cutting  away  all  portions  of  thin  livid  skin  of  low  vitality.  The 
incised  parts  are  maintained  in  perfect  apposition  by  means  of  deep  and 
superficial  sutures  until  adhesion  is  effected. 

In  this  year  Dr.  \\  . H.  Byford  published  an  interesting  paper  upon 
chronic  abscesses  of  the  pelvis,  and  the  following  points  are  made 
prominent : When  the  surface  of  a pelvic  abscess  is  identical  with  that 
of  an  external  ulcer,  granulations  may  be  exuberant  or  freely  movable 
and  flabby  or  firm  and  vigorous.  When  the  granulations  are  exuberant, 
forming  large  projections  into  the  abscess-cavity,  its  surfaces  should  be 
curetted.  The  same  operation  is  also  indicated  when  early  suppuration 
takes  place  in  pelvic  htematoceles,  in  order  to  remove  the  clots  which 
suppuration  cannot  dispose  of.  As  granulations  disappear  and  cicatri- 
zation takes  place  the  contents  of  the  abscess  undergo  changes.  Serum 
exudes,  macerating  and  finally  disintegrating  the  pus-corpuscles  and 
causing  them  to  disappear.  Osmosis  going  on  through  the  cicatricial 
membrane  converts  the  contents  into  simple  serum.  There  then  results 
an  encysted  tumor  containing  serum-like  fluid. 

It  is  believed  that  Dr.  Charles  K.  Briddon  was  the  first  in  the  United 
States  to  perform  laparotomy  after  rupture  of  the  foetal  sac  in  tubal 
pregnancy.  This  lie  did  in  October,  1883. 

Dr.  Matthew  D.  Mann  was  the  first  to  publish  a successful  operation, 
performed  in  February,  1883,  in  which  he  removed  a small  subperitoneal 
fibroid  tumor  of  the  uterus  through  the  anterior  wall  of  the  vagina. 

In  this  year  an  operation  for  the  cure  of  retroversion  of  the  uterus 
was  described  by  J.  B.  Hunter  of  New  York.  Dr.  O.  E.  Herrick  of 
Michigan  had  also  performed  and  reported  the  same  operation,  each 
gentleman  working  independently.  The  latter,  however,  it  is  believed, 
is  entitled  to  the  credit  of  being  the  first  to  perform  the  operation. 
The  operation  consists  of  a denuded  surface  upon  the  posterior  lap  of 
the  uterus  which  is  united  bv  sutures  to  a similarly  denuded  surface 
upon  the  posterior  vaginal  wall. 

In  the  January  number  of  the  American  Journal  of  Obstetrics  of  this 
year  Dr.  Garrigues  of  New  York  published  a paper  upon  laparo- 
elytrotomy.  In  tin’s  paper  he  alluded  to  the  place  of  incision  and  the 
position  of  the  ureters,  and  pointed  out  how  they  might  be  avoided 
during  operations.  Dr.  Polk  of  New  York  had  written  upon  the  sub- 
ject the  previous  year,  and  Dr.  Garrigues  had  himself  investigated  it 
in  1878.  Drs.  Polk  and  Garrigues  agree,  from  experiments  made  upon 
the  cadaver,  that  in  the  operation  of  laparo-elytrotomy  the  ureter  is 
safer  from  injury  if  it  remains  below  rather  than  above  the  incision. 


HISTORICAL  SKETCH  OF  AMERICAN  GYNECOLOGY. 


57 


In  November  of  this  year  Dr.  B.  Bernard  Brown  of  Baltimore  per- 
formed a new  operation  for  the  reduction  of  an  inverted  uterus.  An 
incision  was  made  in  the  fundus  of  the  uterus,  through  which  he  passed 
one  of  Sims’s  large  dilators  up  through  the  cervix,  expanding  the  lat- 
ter to  the  fullest  extent.  He  then  passed  through  hard-rubber  dila- 
tors, and  having  assured  himself,  by  means  of  the  finger,  that  no 
adhesions  existed,  the  incision  of  the  fundus  was  sutured,  and  with 
some  manipulation  the  fundus  was  easily  pushed  up  through  the  now 
dilated  cervix,  and  the  operation  was  complete. 

In  1884  a valuable  paper  was  published  by  Dr.  Palmer  of  Cincin- 
nati, entitled  “Abdominal  Section,  its  Value  and  Range  of  Application 
as  a Means  of  Exploration  and  Treatment.”  This  paper  was  read 
before  the  American  Gynecological  Society,  and  gave  rise  to  much 
valuable  discussion.  In  this  year  an  instructive  paper  by  Dr.  Thomas 
appeared,  entitled  “ Management  of  the  Placenta  after  Laparotomy  in 
Abdominal  Pregnancy  at  Full  Term  or  Beyond.” 

An  unique  and  interesting  article  from  Dr.  Isaac  E.  Taylor  of  New 
York  was  published  upon  physiognomy  of  the  vulva  following  anal 
diseases.  Dr.  Taylor  had  made  observations  in  this  connection  which 
may  be  considered  as  very  useful  in  diagnosis.  He  directs  attention  to 
anal  diseases  causing  changes  in  the  appearance  of  the  vulva  as  painful 
affections,  coming  under  the  head  of — 1st,  spasmodic  contractions  of 
the  anus  ; 2d.  neuralgia  or  hysterical  hyperesthesia  ; 3d,  irritability  or 
indolent  fissure  in  that  locality. 

An  interesting  article  was  published  in  the  American  Journal  of 
Obstetrics  of  November,  1883,  to  March,  1884,  by  Dr.  H.  R.  Bigelow, 
entitled  “ Gastrotomy  for  Myo-fibromata  of  the  Uterus.”  It  is  one  of 
the  most  valuable  contributions  to  our  knowledge  of  the  subject  up  to 
that  time.  He  alludes  to  the  publication  in  1853,  by  W.  L.  Atlee,  of 
a paper  entitled  “Surgical  Treatment  of  Certain  Fibrous  Tumors  of 
the  Uterus  ” as  the  beginning  of  a movement  in  the  treatment  of  ute- 
rine fibroids.  Until  1863  a few  surgeons  at  home  and  abroad,  like 
Atlee,  Burnham,  and  Kimball,  on  opening  the  abdomen  for  ovarian 
tumors,  having  found  a uterine  tumor,  ventured  to  remove  it.  Burnham 
made  a supravaginal  hysterectomy  June  26, 1853,  and  the  patient  recov- 
ered. This  was  the  first  successful  case  in  America.  Afterward  Koeberle 
of  Strasburg  was  the  first  to  deliberately  open  the  abdomen  for  the  purpose 
of  removing  uterine  fibroids  and  fibrous  cysts,  which  he  did  by  ligature 
if  pedunculated,  or  by  the  performance  of  hysterectomy  if  they  were 
intramural  or  sessile.  Dr.  Storer  was  among  the  first  in  America  to 
deliberately  follow  in  his  footsteps.  Dr.  Kimball  of  Lowell  with  equal 
boldness  operated  about  the  same  time  as  Koeberle. 

In  writing  of  early  operators  Bigelow  states  that  “ Kimball  and 
Koeberle  seem  to  be  the  only  ones  whose  operations  were  based  upon  a 


58  HISTORICAL  SKETCH  OF  AMERICAN  GYNECOLOGY. 


correct  diagnosis.”  The  present  status  of  such  a treatment  of  myo- 
fibromata of  the  uterus  was  concisely  set  forth  in  this  year  by  Dr. 
If.  S.  Sutton  of  Pittsburg  in  an  article  on  “ Non-malignant  Tumors 
of  the  Uterus and  several  American  writers  on  uterine  fibroids  give 
Dr.  Goodell  the  credit  of  being  the  first  in  the  United  States  to  remove 
ovaries  to  prevent  further  growth  in  uterine  fibroids,  but  the  date  of  his 
operation  we  are  unable  to  state. 

Dr.  H.  A.  Kelly  of  Philadelphia  reports  a successful  operation  for 
sessile  cervical  fibroids  above  the  vaginal  roof  by  abdominal  incision. 
Free  hemorrhage  was  checked  by  the  use  of  Paquelin’s  cautery  applied 
deep  in  the  peritoneal  cavity.  The  first  successful  case  of  laparotomy 
for  pelvic  abscess  in  this  country  was  made  by  Dr.  R.  S.  Sutton  in 
June,  1884. 

A very  interesting  address  was  made  at  the  meeting  of  the  American 
Gynecological  Society  in  1885  by  Dr.  Wm.  T.  Howard  upon  encysted 
tubercular  peritonitis.  He  had  collected  from  various  sources  six  cases 
in  which  there  was  interference : one  of  these  was  aspirated,  three  tap- 
ped, two  operated  upon  as  in  ovariotomy,  and  all  died.  One  case  was 
simply  treated  by  hygienic  and  therapeutic  measures,  and  recovered. 
Some  of  his  clinical  conclusions  are  that  tubercular  peritonitis  appears 
in  early  life.  Its  development  is  rapid,  varying  from  six  weeks  to 
eight  months.  Being  rarely  a local  affection,  we  should  search  for 
indications  of  the  disease  in  other  parts  of  the  body.  A number  have 
observed  that  a red  blush  of  the  central  anterior  part  of  the  abdom- 
inal wall  is  characteristic  of  tubercular  peritonitis. 

At  the  meeting  of  the  Gynecological  Society  of  this  year  (1885)  quite 
a lengthy  discussion  was  held  upon  modifications  of  Emmet’s  operation 
upon  the  cervix  uteri,  called  forth  bv  a paper  of  Dr.  Sutton’s.  The 
majority  of  the  members  participated  in  this  discussion,  and  the  fact 
was  clearly  demonstrated  that  the  mechanical  ingenuity  of  the  different 
gynecologists  is  of  the  highest  order. 

Dr.  Goodell  reported  this  year  having  observed  a form  of  parotitis 
following  operations  upon  the  female  genital  organs  which  was  not  of 
septic  origin.  That  such  diseases  might  occur  is  owing  to  the  relation- 
ship which  is  known  to  exist  between  the  sexual  organs  of  the  adult 
and  the  cervical  and  salivary  glands.  The  inflammation  observed  by 
Goodell  closely  resembles  mumps,  and  usually  ends  in  resolution  unat- 
tended with  an}*  of  the  signs  of  septicaemia,  such  as  frequency  of  the 
pulse  or  glassy  apearance  of  the  eye.  This  variety  of  parotitis  lasts 
longer  than  mumps.  Instead  of  the  patient  failing  as  in  septic  inflam- 
mation, she  gains  pari  passu  with  the  continued  enlargement  of  the 
glands.  His  first  case  was  reported  to  the  Obstetrical  Society  of  Phil- 
adelphia in  October,  1884. 

In  this  same  year  Dr.  Alfred  C.  Post  of  New  York  reported  a new 


HISTORICAL  SKETCH  OF  AMERICAN  GYNECOLOGY. 


59 


form  of  operation  for  lacerated  perineum,  which  may  be  briefly  described 
as  follows  : An  incision  of  half  an  inch  in  depth  is  made  upon  each  side 
of  the  vagina  in  such  a manner  as  to  make  upper  and  lower  segments. 
The  upper  segments  are  turned  up  to  form  the  floor  of  the  vagina  and 
secured  by  a roAV  of  catgut  sutures  passed  through  the  subcutaneous  tis- 
sues. A row  of  silver  sutures  is  passed  beneath  the  bottom  of  the 
incision.  The  lower  edges  are  also  united  by  flue  sutures. 

In  the  New  York  Medical  Journal  of  this  year  Dr.  John  Scott  of 
San  Francisco  reports  a case  of  chronic  pelvic  abscess  treated  by 
abdominal  incision.  After  the  abscess-cavity  was  washed  out  a drain- 
age-tube was  passed  through  the  incision  into  Douglas’s  cul-de-sac  and 
through  into  the  vagina.  The  abdominal  incision  was  then  closed ; 
recovery. 

In  June  of  this  year  Dr.  B.  E.  Haclra  of  San  Antonio,  Texas,  read 
a paper  before  the  section  of  Diseases  of  Women  at  the  American 
Medical  Association,  entitled  “ Intraperitoneal  Adhesions  in  Relation 
to  Tait’s  Operation.”  He  calls  attention  to  the  marked  relief  in  some 
cases  after  Tait’s  operation  in  which  disease  of  the  tubes  and  ovaries 
was  not  extensive.  This  fact  he  considers  due  rather  to  the  breaking 
up  of  adhesions — namely,  of  the  intestines  to  the  fundus  or  sides  of  the 
uterus ; also  extra-pelvic  adhesions,  especially  adhesions  between  the 
omentum  and  parietal  or  visceral  peritoneum.  He  advocates  laparot- 
omy for  a new  purpose — namely,  to  free  the  peritoneum  throughout  its 
entire  area. 

In  a paper  on  vulvar  and  vaginal  enterocele,  read  before  the  New 
York  Academy  of  Medicine  in  1885,  Dr.  T.  G.  Thomas  advocated  a 
new  method  of  treatment  for  vaginal  enterocele  in  cases  not  amenable 
to  the  ordinary  measures — namely,  laparotomy  and  dragging  up  the 
hernial  sac  and  fastening  it  to  the  abdominal  wound.  He  reports  one 
case  in  which  this  plan  was  partially  pursued  with  successful  result. 

In  a series  of  articles  in  the  American  Journal  of  Obstetrics  in  1885, 
entitled  “ Studies  in  Endometritis,”  Dr.  Mary  Putnam-Jacobi  further 
develops  the  cyclical  theory  of  menstruation  which  was  first  enunciated 
in  1878  by  Dr.  Goodman  of  Louisville.  The  theory  which  she  sets 
forth  is  substantially  as  follows  : The  endometrium  above  the  os  inter- 
num, the  mucosa  of  the  Fallopian  tubes,  and  the  cortex  of  the  ovaries 
are  designated  as  the  “ germinative  membrane.”  “The  epithelium  and 
subepithelial  cells  of  this  membrane  are  directly  derived  from  the  ger- 
minal epithelium  of  the  embryonic  hvpoblast.  which  covers  the  repro- 
ductive eminences  of  the  pleural-peritoneal  cavity.”  . . . . “ In  all  the 
elements  of  germinative  membranes  persists  the  embryonic  property 
of  indefinite  growth.”  This  process  is  changed  from  continuous  to 
cyclical  through  the  mechanical  obstructions  which  are  encountered 
after  a certain  point  in  growth  is  reached.  Dr.  Jacobi,  like  Dr.  Good- 


60 


HISTORICAL  SKETCH  OF  AMERICAN  GYNECOLOGY. 


man,  separates  ovulation  and  menstruation  as  far  as  cause  and  effect  arc 
concerned.  Ovulation  and  menstruation  are  usuallv  synchronous.  The 
former  does  not  cause  the  latter,  but  both  are  produced  by  the  same 
cause — namely,  growth  of  embryonic  tissue. 

In  1885,  Dr.  Baird  of  Texas  advocated  a new  method  for  the  treat- 
ment of  pelvic  cellulitis  for  arresting  exudation  and  pain,  and  applies 
the  galvanic  current.  He  reports  a case  also  where  pus  had  formed, 
which  he  evacuated  by  aspiration,  and  then  injected  the  cavity  with 
salt  water,  and  applied  a galvanic  current  to  the  cavity,  with  the  result 
of  speedy  contraction  of  the  abscess  and  radical  cure. 

In  1886,  Dr.  Sarah  E.  Post  published  in  the  American  Journal  of 
the  Medical  Sciences  an  exhaustive  resume  upon  the  subject  of  kolpo- 
hvsterectomy,  which  comprises  a collection  of  all  cases  on  record,  with 
a short  history  and  description  of  each  of  the  various  modes  of  ope- 
rating. 

Dr.  H.  Marion  Sims  of  New  York  read  this  same  year,  before 
the  New  York  Obstetrical  Society,  a paper  on  ventral  hernia  following 
ovariotomy,  in  which  he  advocates  a radical  operation  for  its  cure.  In 
a patient  who  suffered  very  much  pain  on  account  of  the  hernia,  the 
hernial  ring  being  ten  inches  in  diameter,  he  excised  an  elliptical  piece 
of  skin,  and  then  united  the  peritoneum  by  Lembert  sutures.  Then 
the  muscles  and  fasciae  were  united  separately  with  catgut  and  silver 
wire.  The  result  was  a perfect  recovery. 

Dr.  Polk  of  New  York  reported  to  the  Obstetrical  Society  of  New 
York  a case  of  pelvic  abscess  which  was  operated  upon  outside  of  the 
peritoneum  bv  means  of  an  incision  made  as  in  that  for  ligating  the 
iliac  artery,  the  patient  recovering. 

January  20th  of  this  year  the  first  annual  meeting  of  the  Alumni  As- 
sociation of  the  Woman’s  Hospital  of  the  State  of  New  York,  composed 
of  former  medical  officers  and  house-surgeons,  was  held.  A permanent 
organization  was  effected,  and  Dr.  J.  B.  Hunter  was  chosen  president. 
At  this  meeting  many  interesting  papers  were  read  and  discussed,  most 
of  which  have  been  published  in  medical  journals ; a history  of  the 
institution  was  also  read,  it  being  altogether  a meeting  of  the  alumni. 

In  mentioning  the  historical  points  heretofore  the  writer  has  aimed 
to  pursue  a chronological  order,  but  there  are  some  items  relating  to 
gynecological  history  which,  being  matters  of  development,  can  hardly 
be  spoken  of  as  pertaining  wholly  to  any  one  year,  and  therefore  will 
now  be  alluded  to. 

In  this  connection  attention  is  directed  to  the  use  of  electricity  in 
t he  treatment  of  uterine  fibroids.  Among  those  who  have  investigated 
this  subject  and  experimented  and  published  their  results  may  be  men- 
tioned Dr.  J.  N.  Freeman  of  Brooklyn,  Dr.  Engelmann  of  St.  Louis, 
Dr.  Everett  of  Clyde,  O.,  Dr.  Martin  of  Chicago.  These  gentlemen 


HISTORICAL  SKETCH  OF  AMERICAN  GYNECOLOGY. 


61 


have  written  upon  electrolysis  in  the  treatment  of  snbperitoneal  and 
intramural  fibroids.  Drs.  Thomas,  Munde,  Vanderveer,  and  Semelleder 
of  Mexico  have  experimented  and  written  upon  electrolysis  in  the  treat- 
ment of  ovarian  tumors.  Dr.  Munde  gives  a report  of  fifty-one  cases 
which  he  has  collected  from  various  sources,  of  which  there  were  nine 
deaths  and  fourteen  failures,  the  remainder  being  benefited  or  cured. 

In  1874,  Dr.  Gilman  Kimball  published  in  the  Boston  Medical 
Journal  a paper  entitled  “ Treatment  of  Uterine  Fibroids  by  Electrol- 
vsis  or  Galvanism.”  In  1878,  Ephraim  Cutter  reported  fifty  cases  of 
uterine  fibroids  treated  by  electrolysis  by  Kimball  and  himself.  These 
cases  were  treated  during  the  period  extending  from  1871  to  1877,  with 
the  following  results  : Hon-arrests,  7 ; death,  4 ; arrests,  32 ; relieved, 
3;  cured,  4.  Writing  of  these  cases  nine  years  later  (in  1887),  Cutter 
shows  that  time  has  served  to  strengthen  rather  than  weaken  the  posi- 
tion which  he  and  Kimball  took  as  pioneers  of  this  method,  for  the 
present  resume  of  those  same  fifty  cases  now  stands  thus  : Xon-arrests, 
7 ; fatal,  4;  arrests,  25;  relieved,  3;  cured,  11. 

Dr.  Robert  Newman  of  New  York  is  the  veteran  advocate  in  America 
of  the  electrolytic  treatment.  He  reported  the  results  of  some  of  his 
labors  in  this  direction  as  early  as  1867.  Reports  of  successful  cases 
of  electrolysis  in  extra-uterine  pregnancy  have  been  made  by  Drs.  A. 
D.  Rockwell,  T.  G.  Thomas,  E.  G.  Landis,  X.  Bozeman,  Garrigues,  J. 
C.  Reeve,  William  T.  Lusk,  and  others. 

Hot  water,  which  is  so  generally  made  use  of  in  the  treatment  of 
diseases  peculiar  to  women,  and  has  had  such  an  ardent  advocate  in 
Dr.  Emmet,  was  first  brought  to  the  attention  of  the  profession  as  a 
haemostatic  during  surgical  operations  by  the  late  Dr.  Pitcher  of  Detroit 
in  1859. 

A valuable  contribution  to  gynecology  has  been  made  by  Dr.  IT. 
Coe,  the  pathologist  of  the  Woman’s  Hospital  of  Xew  York.  His 
published  observations  of  certain  conditions  of  the  ovaries  have  been 
revelations  to  many  who  believed  that  anything  appearing  like  a cyst 
upon  the  ovary  indicates  disease  demanding  removal.  Some  of  his 
conclusions  are  as  follows : Laparotomists  often  judge  of  ovarian  dis- 
eases by — 1st,  thickening  of  the  cortex  of  ovaries  : such  thickening  is 
perfectly  normal  in  the  senile  organ  or  after  frecpient  ovulation ; 2d,  by 
the  appearance  of  a “ cystic  ” degeneration,  which  is  often  only  hydrops 
folliculorum,  and,  according  to  Olshausen,  “ the  stroma  of  the  ovary 
in  these  cases  is  intact  and  most  of  the  vesicles  are  normal.”  This  con- 
dition seldom  attains  any  clinical  importance,  because  the  changes  pro- 
duce no  symptoms.  Dr.  Coe  states  the  case  of  a perfect  ovum  found 
within  a Graafian  vesicle  as  large  as  a marble.  Of  a large  number  of 
tubes  removed  by  different  operators  which  Coe  has  examined,  only  one- 
fifth  had  true  pyosalpinx.  A less  number  were  affected  with  hydro- 


62 


HISTORICAL  SKETCH  OF  AMERICAN  GYNECOLOGY. 


salpinx,  and  only  one  with  hsematosalpinx.  An  acute  catarrhal  sal- 
pingitis had  been  found  in  women  who  had  died  from  acute  peritonitis 
following  extension  of  acute  purulent  endometritis.  Chronic  catarrhal 
salpingitis  he  has  not  found.  Thickening  of  the  fibroid  muscular  tis- 
sue without  evidence  of  inflammation  is  rare.  This  condition  has  been 
designated  pachysalpingitis.  Coe  gives  this  as  a rule : Unless  pus  is 
found  there  is  no  pyosalpinx. 

In  1882,  Dr.  Baker  of  Boston  originated  the  cone-shaped  excision 
of  the  neck  of  the  uterus  for  cancer,  the  apex  of  the  cone  being  carried 
far  above  the  os  internum.  Dr.  Baker  has  also  cured  a case  of  con- 
genital malposition  of  the  ureter.  The  ureter  opened  into  the  vagina 
near  the  meatus  urinarius.  He  dissected  up  a portion  of  the  misplaced 
ureter,  made  an  opening  in  the  original  bed  near  the  neck  of  the  blad- 
der, and  turned  the  stump  through  it  and  closed  the  vaginal  wall  over 
it.  About  a year  after  he  was  obliged  to  open  the  bladder  and  remove 
a stone  which  had  probably  formed  as  the  result  of  leaving  a raw  sur- 
face in  the  bladder.  Phosphates  are  often  deposited  upon  such  surfaces. 

In  1 886,  at  a meeting  of  the  American  Medical  Association,  Dr.  A. 
F.  Pattee  reported  great  success  for  many  years  with  potassium  chloride 
in  the  treatment  of  anaemia,  exudations  from  pelvic  cellulitis  in  ovarian 
neuralgia,  menstrual  headache  with  wakefulness,  he  having  found  the  rem- 
edy more  advantageous  than  potassium  bromide  or  ammonium  chloride. 

Dr.  Byrne  of  Brooklyn  in  the  October  and  December  numbers  of  the 
New  York  Medical  Journal  for  1878  published  a new  method  of  redu- 
cing; inversion  of  the  uterus  by  means  of  an  instrument  consisting;  of  a 
curved  stem,  to  the  end  of  which  is  attached  a cup  for  receiving  the 
inverted  uterus.  The  stem  is  traversed  by  a rod  which  is  affixed  to 
a disk  forming  a false  bottom  of  the  cup.  Counter-pressure  upon  the 
abdomen  is  maintained  by  means  of  an  open  bell-shaped  cup,  through 
the  ceutre  of  which  passes  a screw  provided  at  the  lower  end  with  a 
conical  plug  of  hard  rubber,  and  on  the  opposite  or  lower  extremity  a 
flat  knob  for  a handle. 

Heretofore,  in  speaking  of  the  mechanical  treatment  of  uterine  dis- 
placements, credit  has  been  given  to  Dr.  Hodge  for  his  ingenuity,  but 
American  ingenuity  has  been  taxed  to  its  utmost  in  the  invention  of 
pessaries,  the  most  valuable  of  which  are  some  form  or  modification  of 
the  one  originally  invented  by  Hodge.  Among  those  most  worthy  of 
mention  are  the  pessaries  of  Thomas,  Emmet,  and  Albert  H.  Smith. 
Gehrung  of  St.  Louis  has  devised  various  forms — one  particularly 
useful  in  anteversion  or  procidentia  accompanied  by  anteversion  or 
cystocele — and  so  has  Cutter.  All  forms  of  gynecological  instru- 
ments have  been  devised,  and  there  is  scarcely  an  operator  but  has 
originated  or  modified  some  form  of  instrument,  to  which  his  name 
is  attached. 


HISTORICAL  SKETCH  OF  AMERICAN  GYNECOLOGY. 


63 


One  of  the  improved  pessaries  is  the  block-tin  pessary  devised  by 
Sims  about  1859.  He  recognized  the  necessity  of  having  a pessary  fit 
the  canal  in  which  it  Avas  to  be  placed,  and  devised  pessaries  from  that 
material  to  accomplish  this  purpose. 

Prior  to  Dr.  Sims’s  book  most  of  the  works  published  in  this  coun- 
try upon  diseases  of  women  were  either  foreign  Avorks  edited  by  Ameri- 
can physicians  or  were  treatises  chiefly  upon  diseases  of  the  puerperal 
state.  In  1826  Avas  published  the  treatise  on  Diseases  of  Females , by 
William  P.  Dewees.  This  book  reached  its  tenth  edition.  From  1852 
to  1855  the  clinical  lectures  of  Dr.  G.  S.  Bedford  Avere  published  in 
medical  journals,  after  which  they  were  published  in  book  form.  The 
Avorkof  Dr.  C.  D.  Meigs,  published  in  1850,  which  ran  through  seA'eral 
editions  and  Avas  written  in  the  most  charming  manner,  was  in  no  degree 
a representative  of  modern  gynecology.  In  1860  Avas  published  Dis- 
eases Peculiar  to  Women,  including  Displacements  of  the  Uterus,  by  Hugh 
L.  Hodge.  The  first  edition  of  Bvford’s  work  upon  medical  and  sur- 
gical treatment  of  Avomen  AA’as  in  1865.  Dr.  Marion  Sims’s  book,  en- 
titled Clinical  Notes  on  Uterine  Surgery,  was  published  in  1866.  In 
1868  a treatise  upon  vesico-vaginal  and  \Tesico-rectal  fistulas,  by  T.  A. 
Emmet,  AA’as  published.  In  1868  Avas  published  a book  by  T.  Gail- 
lard  Thomas  entitled  Practical  Treatise  upon  the  Diseases  of  Women. 
This  Avork  Avas  the  fullest  and  most  systematic  treatise  that  had  eA’er 
emanated  from  an  American  author.  As  early  as  1880,  so  great  had 
been  the  demand  for  this  book,  it  had  run  through  four  editions,  and 
the  fifth  Avas  published,  much  revised  and  enlarged.  Especially  note- 
Avorthy  are  the  chapters  entitled  respecth’ely  “An  Historical  Sketch 
of  Gynecology  ” and  “ The  Anatomy,  Physiology,  and  Pathology  of 
the  Female  Perineum.”  The  former  is  a concise  and  most  interesting 
article  on  gynecology,  dating  back  to  ancient  times.  The  latter,  an 
ably-written  chapter,  lias  especial  reference  to  the  functions  of  the 
perineal  body  and  the  necessity  of  restoring  it  after  rupture,  even 
though  incomplete. 

The  first  journal  devoted  to  obstetrics  and  gynecology  appeared  in 
1868,  edited  by  Dr.  B.  F.  DaAvson,  to  AA’hose  energy  and  untiring  efforts 
chiefly  this  journal  OAves  its  origin.  It  first  appeared  as  a quarterly. 
After  some  years  Dr.  DaAvson  AATas  succeeded  by  its  present  able  editor, 
Dr.  Munch}.  The  first  journal  deA'oted  especially  to  gynecology  Avas 
the  Journal  of  the  Gynecological  Society  of  Boston,  edited  by  Drs.  H. 
R.  Storer,  G.  H.  Bixby,  and  W.  LeAvis.  It  first  appeared  in  1869, 
and  exercised  no  inconsiderable  amount  of  influence. 

In  1872,  Dr.  E.  X.  Chapman,  a former  professor  of  obstetrics 
and  diseases  of  women  in  the  Long  Island  College  Hospital,  pub- 
lished his  work  on  Diseases  and  Displacements  of  the  Uterus,  which 
met  Avith  rather  rough  usage  at  the  hands  of  reA’ieAvers,  although 


64 


HISTORICAL  SKETCH  OF  AMERICAS  GYNECOLOGY. 


possessing  considerable  merit.  The  book  never  reached  its  second 
edition. 

In  1872,  Dr.  John  Byrne’s  (of  Brooklyn)  monograph,  entitled  Clin- 
ical Notes  on  the  Electric  Cautery  in  Uterine  Surgery , was  published. 
Notwithstanding  this  gentleman’s  enthusiastic  advocacy  of  the  electric 
cautery  and  the  good  showing  of  his  clinical  reports,  this  mode  of 
treatment  is  not  at  the  present  time  held  in  the  high  esteem  it  once 
was  by  leading  American  gynecologists. 

In  1872  was  published  by  Appletons  the  truly  classical  work  On 
Ovarian  Tumors,  by  Edmund  R.  Peaslee,  Avhich  was  dedicated  “ To 
the  memory  of  Ephraim  McDowell,  M.  D.,  the  father  of  ovariotomy, 
and  to  Thomas  Spencer  Wells,  Escp,  the  greatest  of  ovariotomists.” 
Of  this  great  work  his  friend  and  biographer,  Professor  Fordyce 
Barker,  writes  for  the  third  volume  of  the  Transactions  of  the  Amer- 
ican Gynecological  Society : “ No  work  has  been  published  in  this  coun- 
try on  any  special  subject  of  medical  science  of  higher  merit  than  his, 
as  regards  its  plan  of  arrangement,  its  artistic  excellence  of  execution, 
its  literary  finish,  its  learned,  impartial,  historical  research,  its  sound- 
ness in  pathology,  its  keen  analytical  teaching  of  diagnosis,  its  wise, 
prudent,  practical,  and  thorough  directions  as  regards  treatment,  both 
in  the  medical  and  surgical  aspects  of  the  subject.”  This  work  will  lie 
“ an  imperishable  monument  to  his  name.” 

Soon  after  Peaslee’s  book  was  published  appeared  another  work  (in 
1873)  on  Ovarian  Tumors,  which  had  been  announced,  and  the  publi- 
cation of  which  had  been  eagerly  anticipated  by  all  interested  in  the 
operation  of  ovariotomy  in  the  United  States.  The  work  referred  to 
was  written  by  Washington  L.  Atlee,  who  up  to  this  date  had  made 
more  ovariotomies  than  any  other  American.  This  truly  valuable  book 
differs  widely  from  Peaslee’s,  as  it  is  more  purely  clinical  and  personal, 
showing  as  it  does  the  many  years  of  its  author’s  labors  as  a pioneer 
ovariotomist.  The  twenty-fourth  chapter  of  this  volume,  entitled 
“ Dropsical  Fluids  of  the  Abdomen,  their  Physical  Properties,  Chem- 
ical Analysis,  Microscopic  Appearance,  and  Diagnostic  Value,  based  on 
the  Examination  of  Several  Hundred  Specimens,”  was  contributed  by 
Dr.  Thomas  M.  Drysdale. 

In  1876  appeared  the  first  volume  of  the  Transactions  of  the  Ameri- 
can Gynecological  Society,  which  have  appeared  from  year  to  year  since 
that  time.  Allusion  has  herein  before  been  made  to  the  organization 
of  this  society  and  the  influence  which  it  has  exerted  on  the  progress 
of  gynecology  in  this  country.  Xor  has  this  influence  been  confined  to 
the  United  States  alone,  but  has  been  felt  in  foreign  countries.  After 
the  appearance  of  the  sixth  volume  of  the  Transactions  the  following 
introduction  to  a translation  of  one  of  its  articles  by  the  distinguished 
Prof.  Kleinwachter  appeared  in  the  Deutsches  Archiv  fur  Geschichte  dcr 


HISTORICAL  SKETCH  OF  AMERICAN  GYNECOLOGY. 


65 


Med.  u Med.  Geog.,  in  which  the  translation  was  published.  After 
writing  at  some  length  in  a commendatory  manner  of  the  foundation 
of  the  society  and  its  founders  and  Transactions,  he  says  : “ Up:  to  the 
present  time  six  volumes  have  appeared,  which  are  an  ornament  to  our 
libraries  of  special  sciences  and  contain  an  abundance  of  highly  inter- 
esting and  valuable  contributions,  as  would  be  expected,  for  amongst 
the  co-workers  may  be  enumerated  such  men  as  Washington  Atlee, 
Fordyce  Barker,  William  By  ford,  Thomas  Addis  Emmet,  George  En- 
gelmann,  William  Goodell,  Charles  Carroll  Lee,  William  Lusk,  Paul 
Munde,  Emil  Hoeggerath,  Randolph  Peaslee,  the  universally-known 
and  celebrated  Dr.  J.  Marion  Sims,  T.  Gailiard  Thomas,  and  others 
whose  scientific  reputation  is  everywhere  known  and  recognized.” 
Aside  from  the  scientific  interest  which  the  Transactions  possess, 
Ivleinwachter  considers  the  medico-historical  characteristics  note- 
worthy : “ The  previous  volumes  contain  full  biographies  of  Simon 
(of  Heidelberg),  Charles  Buckingham,  Randolph  Peaslee,  Marmaduke 
B.  Wright,  and  others.  The  fifth  volume  contains  an  extensive  paper, 
illustrated  with  numerous  cuts,  upon  midwifery  among  the  various 
peoples  of  the  globe,  by  Engelmann,  and  in  the  sixth  is  a noticeable 
contribution  from  the  pen  of  Edward  W.  Jenks  entitled  ‘ The  Prac- 
tice of  Gynecology  in  Ancient  Times.’  ”....“  If  the  English  and 
French  cultivate  the  history  of  medicine,  we  need  be  less  surprised,  for 
both  of  these  nations  possess  a famous  history  of  more  than  a thousand 
years,  and  such  a one  doubtless  stimulates  historical  research.  The 
Americans  are  without  an  ancient  national  culture,  and  therefore  with- 
out an  ancient  history,  and  yet  we  see  them  fostering  the  history  of 
medicine.  With  this  people  y.a.z  iqoyfv  of  the  present,  necessitv  has 
compelled  it  to  make  a path  for  itself,  in  order  to  learn  what  the 
ancients  knew  and  did,  in  order  not  to  be  too  one-sided — in  other 
words,  more  fully  to  comprehend  the  spirit  of  medicine  than  it  is 
possible  by  the  modern  methods  of  so-called  exact  investigation.” 

In  1878  was  established  the  Obstetric  Gazette,  published  in  Cincin- 
nati and  edited  by  Edward  B.  Stevens ; it  has  also  a department 
devoted  to  diseases  of  women. 

Dr.  Skene’s  book,  entitled  Diseases  of  the  Bladder  and  Urethra  of 
Women,  first  came  out  in  1878.  This  volume  is  the  only  one  of  its 
kind  which  has  been  published  in  this  country,  and  its  intrinsic  value 
has  greatly  served  to  establish  and  extend  the  justly-deserved  reputa- 
tion of  its  author  as  an  authority  on  the  disorders  of  which  it  treats. 

In  1879,  Emmet  published  his  work  entitled  Principles  and  Practice 
of  Gyncecology.  This  work  is  a clinical  work,  and  is  totally  unlike  the 
systematic  treatise  of  Thomas.  Owing  to  the  author’s  long  connection 
with  the  Woman’s  Hospital  of  the  State  of  Hew  York,  first  as  assistant 
to  Dr.  Sims,  next  as  surgeon-in-chief  for  many  years,  and  later  as  one 

VOL.  I. — 0 


66  HISTORICAL  SKETCH  OF  AMERICAN  GYNECOLOGY. 


of  the  surgeons  of  the  staff,  his  experience  has  given  him  great  advan- 
tages in  the  way  of  clinical  observation,  of  which  his  book  bears  an 
abundant  evidence.  This  book  has  passed  through  several  editions, 
the  last  one  being  practically  a new  book,  so  much  has  been  rewritten 
and  added  since  the  first  edition  appeared. 

In  1879  was  published  the  clinical  lectures  of  Dr.  Win.  Goodell  of 
Philadelphia,  entitled  Lessons  in  Gyncecology. 

In  1881  a new  edition  of  By  ford’s  work  was  published  on  the  dis- 
eases of  women,  but  so  changed  from  the  first  edition  as  to  be  practi- 
cally a new  work,  fully  abreast  of  the  times  and  worthy  of  its  indus- 
trious author. 

In  1880,  Munde  published  a work  entitled  Minor  Surgical  Gyne- 
cology. The  second  edition  appeared  in  1885 — a work  of  great  use 
to  the  younger  members  of  the  profession,  for  whom  chiefly  it  is 
written. 

Obstetrical  societies  were  formed  man}'  years  ago  in  a few  of  the  larger 
cities,  but  the  first  gynecological  society  organized  was  the  Gynecolog- 
ical Society  of  Boston,  established  in  1869.  Its  Transactions,  pub- 
lished monthly,  exerted  a widespread  influence  on  the  interests  of 
gynecology,  which  was  due  chiefly  to  the  labors  of  Dr.  H.  R.  Storer 
and  a few  of  his  colleagues.  Although  the  journal  has  been  discon- 
tinued, Dr.  Storer  having  been  compelled  to  withdraw  from  active 
work  by  reason  of  his  illness,  the  society  continues  to  hold  its  stated 
meetings. 

Other  obstetrical  and  gynecological  societies  have  been  established 
quite  universally.  Where  obstetrical  societies  exist,  gynecology  shares 
with  obstetrics  in  the  attention  which  is  devoted  to  it.  Gynecological 
societies  exist  in  Washington,  Chicago,  Detroit,  Baltimore,  and  sev- 
eral other  cities,  while  the  principal  part  of  the  work  of  the  obstetri- 
cal societies  of  ISjfew  York,  Philadelphia,  and  some  other  cities  seems 
to  be  gynecological. 

In  1870  the  American  Medical  Association  passed  resolutions  recom- 
mending that  the  establishment  of  chairs  of  gynecology  separate  from 
that  of  obstetrics  be  more  generally  adopted  by  medical  colleges  and 
schools  throughout  the  country.  The  direct  cause  of  these  resolutions 
was  a memorial  presented  to  the  association  by  the  Boston  Gynecolog- 
ical Society.  The  Medical  College  at  Castleton,  Yt.,  was  the  first  one 
in  which  special  attention  was  given  to  the  diseases  of  women,  Dr. 
Woodward  lecturing  upon  gynecology  as  well  as  upon  obstetrics.  Prob- 
ably the  first  college  to  found  a full  professorship  of  gynecology  was 
Dartmouth,  Dr.  Peaslee  being  its  incumbent.  About  the  same  time  Dr. 
H.  R.  Storer  gave  a fidl  course  of  lectures  on  gynecology  in  Berkshire 
Medical  College,  Massachusetts,  of  which  institution  he  was  professor 
of  obstetrics  and  diseases  of  women. 


HISTORICAL  SKETCH  OF  AMERICAN  GYNECOLOGY.  67 


As  early  as  1871  there  were  thirteen  medical  colleges  in  the  United 
States  in  which  there  were  full  professorships  of  gynecology  and  of 
obstetrics.  Of  this  number,  there  were  seven  schools  with  full  profes- 
sorships of  the  diseases  of  women,  incumbents  teaching  nothing  else — 
namely,  the  Albany  Medical  College,  E.  R.  Peaslee  ; Long  Island  Hos- 
pital College,  A.  J.  C.  Skene ; St.  Louis  College  of  Physicians  and 
Surgeons,  M.  A.  Pallen ; University  of  Louisville,  T.  Parvin  ; the 
Medical  College  of  Ohio,  C.  D.  Palmer;  University  of  Pennsylvania, 
Win.  Goodell ; Detroit  Medical  College,  Edward  W.  Jenks ; and  there 
were  eight  professorships  of  gynecology  and  the  diseases  of  children 
combined — namely,  University  of  New  York,  F.  D.  Lente ; Medical 
College  of  Virginia,  J.  S.  D.  Cullen ; University  of  Maryland,  W.  D. 
Howard ; Washington  University,  Baltimore,  M.  P.  Scott ; Miami 
Medical  College,  B.  F.  Richardson ; Indiana  Medical  College,  T.  B. 
Harvey  ; Medical  College  of  Evansville,  D.  Morgan  ; Louisville  Med- 
ical College,  J.  A.  Ireland.  Since  then  the  authorities  governing 
medical  schools  and  colleges,  realizing  the  importance  of  gynecology, 
have  in  almost  every  instance  added  a separate  professorship  of  that 
specialty. 

The  foregoing  historical  sketch  of  the  rise  and  progress  of  gynecology 
in  America,  imperfect  though  it  necessarily  be,  can  scarcely  fail  to 
impress  the  reader  with  a sense  of  the  important  part  which  this 
country  has  borne  in  the  development  of  this  division  of  medicine. 
The  profession  of  America  has,  in  what  it  has  already  accomplished, 
both  demonstrated  a peculiar  aptness  in  this  particular  field  and  given 
a guarantee  for  the  future.  With  the  increasing  facilities  which 
increasing  wealth,  and  its  accompaniment  of  growing  freedom  from 
the  mere  money-getting  obligations  resting  on  physicians,  and  the 
enthusiasm  in  their  work  which  seems  to  an  extent  to  be  peculiar  to 
workers  in  this  field,  the  future  of  gynecology  in  this  country  is  big 
with  hope  and  promise.  It  is  but  fitting  that  the  land  which  furnished 
the  pioneers  should  furnish  also  those  who  shall  carry  on  to  its  fullest 
possible  perfection  the  work  so  auspiciously  begun.  The  mantles  of 
McDowell  and  Sims  and  Peaslee  and  the  Atlees  have  fallen  on  worthy 
shoulders,  and  coming  generations  will  accord  to  many  now  living 
places  beside  the  pioneers  who  have  rested  from  their  labors. 


THE  DEVELOPMENT  OF  THE  FEMALE 
GENITALS. 


By  HENRY  J.  GARRIGUES,  A.  M.,  M.  D., 
New  York. 


As  in  other  departments  of  the  history  of  the  development  of  the 
human  body,  so  our  knowledge  of  the  earliest  stages  of  development 
of  the  female  genitals  is  chiefly  derived  from  the  study  of  the  develop- 
ment of  the  corresponding  parts  in  animals,  especially  the  chicken  and 
the  rabbit. 

The  Wolffian  Ducts.1 

The  first  organs  belonging  to  the  genital  sphere  which  appear  in 
the  male  and  female  are  the  Wolffian  ducts.  In  the  chicken  embryo 
they  appear  during  the  latter  half  of  the  second  day.  There  is  one 
on  either  side.  It  begins  at  the  level  of  the  fourth  or  fifth  proto  ver- 
tebra,  and  extends  rapidly  backward,  so  that  at  the  beginning  of  the 
third  day  it  reaches  the  last  protovertebra.  At  first  it  is  a solid  column, 
which  later,  by  the  formation  of  a cavity  in  its  interior,  is  transformed 
to  a tube.  On  cross-section  of  embryos  it  makes  its  first  appearance 
as  a small  protuberance  from  the  lateral  plates  where  they  come  together 
with  the  protovertebral  columns. 

The  posterior  end  of  the  Wolffian  duct  opens  into  that  part  of  the 
allantois  which  is  situated  within  the  body  of  the  embryo,  and  com- 
municates with  the  cloaca,  and  later,  after  the  separation  between  the 
intestinal  and  urogenital  canal  has  taken  place,  into  the  urogenital 
sinus  described  below. 

In  the  rabbit  the  Wolffian  duct  appears  at  the  end  of  the  eighth  or 
the  beginning  of  the  ninth  day,  and  is  developed  in  the  same  way  as 
in  the  chicken.  On  the  eleventh  day  it  opens  into  the  urogenital  sinus. 
Fig.  1 shows  its  situation  between  the  protovertebral  column,  the  lat- 
eral plate,  and  the  descending  aorta.  On  one  side  it  is  yet  a solid 
string,  on  the  other  it  has  begun  to  be  changed  into  a canal.  In  Fig. 
2 we  see  it  open  into  the  urogenital  sinus.  Its  lower  end  lies  on  either 
side  of  the  body,  imbedded  in  a ridge  which  Waldeyer  has  denominated 
plica  urogenitalis.  According  to  the  same  author,  the  Wolffian  duct  is 

1 Casper  Friedrich  Wolff,  Theoria  General innis,  Berlin,  1759;  “On  the  Development 
of  the  Intestine,”  in  Nov.  Comment.  Acad.  Pelropol..  1708-69. 

68 


AUTHORS’  INDEX 


[See  also  lists  of  Literature  referred  toon  pp.  93.  278,  548,  568,  586,  593,  599,  61S,  635.] 


A. 

Adelon,  445 

Agnew,  D.  H.,  28,  41,  725 
Aikman,  John,  252 
Albucasis,  22 
Andral,  695 

Apostoli,  387,  399,  400,  403 
Appleton,  22 

Aran,  377,  568,  664,  677,  696,  707,  723,  727, 
752,  769 

Arcliigenes,  676 
Aetius,  20,  676 
Atlee,  J.  L.,  27 
Atlee,  W.  L.,  27,  28,  64 
Atthill,  568,  580,  653,  664 


B. 

Baird,  60 

Baker,  W.  H„  62,  261 
Balfour,  86,  176 
Ball,  John,  41,  433,  765 
Bandl,  163,  219,  707,  736,  739,  741,  745, 
755,  756,  760,  761,  762,  765,  768 
Barbour,  101 

Barker,  Fordvce,  38,  395,  484,  5S1 
Barnes,  Robert,  568,  581,  583,  722,  736, 
: , 738,  740,  742,  750,  755,  756,  768 
Barstellberger,  263 
Battey,  Robert,  36,  38,  39,  49 
Beard  and  Rockwell,  385 
Beck,  Jos.  R.,  43,  433,  765 
Beck,  Snow,  639,  646,  738,  745,  755 
Becquerel,  727 
Bedford,  G.  D.,  30,  63,  738 
Beliier,  709 

Beigel,  70,  167,  738,  765 
Bell,  24 

Bennet,  377,  568,  571,  573,  576,  581,  661, 
738 

Bernutz,  568,  677,  687,  688,  689,  691,  693, 
694,  695,  696,  700,  704,  715,  717,  727, 
735,  736,  737,  739,  740,  742,  752,  755, 
760,  765,  766,  767,  768 
Bigelow,  Henry  .J.,  52 
Bigelow,  H.  R.,  57 
Biliinger,  J.,  27 
Billroth,  712 
Bird,  547 
Bischoff,  409 
Bixby,  G.  H.,  63,  725 


Boehm,  C.,  93 
Boerner,  600 
Boisin  and  Duges,  447 
Boisin,  Mad.,  157 
Bouchnt,  69S 
Boynham,  Wm.,  28 
Bozeman,  Nathan,  34,  36,  445 
Brandt,  616 

Braun,  C.,  568,  738,  755 
Breisky,  260 
Brickell,  46,  49 
Briddon.  Charles  K.,  56 
Broca,  100 

Browne,  B.  Bernard,  57 
Budin,  P.,  93,  119 
Bumstead,  593 
Burns,  640 
Buttles,  M.  S.,  39 

Bvford,  W.  PI.,  36,  45,  56,  63,  66,  542,  568, 
581,  723,  725,  728,  733 
Byrne,  John,  38,  62,  64,  738 


C. 

Cadiat,  124 
Campbell,  H.  F.,  45 
Carrard,  477 
Carreau,  J.  D.,  6S1 
Carrington,  224,  225 

Chadwick,  J.  R.,  45,  46,  53,  198,  199.  480, 
692 

Championniere,  554,  679,  680 

Channing,  W alter,  30 

Chapman,  E.  N.,  63 

Chauvau,  93 

Clirobak,  135,  141 

Chromel,  641.  661 

Churchill,  Fleetwood,  640,  676,  738 

Clark,  29 

Clark,  Alonzo,  30 

Clark,  C.  M.,  531 

Clark,  Edward  H..  45 

Coe,  H.  C.,  61,  336,  69S,  699 

Coen,  242 

Coleman,  J.  D.,  259 
Cooper,  Astley,  4S3 
Cornil,  91,  519 

Courtv,  A.,  91,  93,  445,  554,  568,  581,  641, 
664,  680,  681,  709,  715,  723,  740.  746, 
763.  766 
Crede,  738 


771 


772 


A UTHORS  ’ INDEX. 


Creighton,  178 
Cruveilhier,  252 
Cullerier,  593 

Cnllingworth,  C.  J.,  691,  722 

D. 

Dalton,  178 
Davies,  Gorner,  258 
Davis,  E.  Y.,  515 
Dawson,  B.  F.,  63 
Deces,  742 
Delore,  756 
Delrand,  515 
Denouviliers,  737 
Deralz,  740 
Dewees,  Wm.  P.,  63 
Dohrn,  E.,  72,  93,  262 
Dolbeau.  741,  757 
Doran,  180 
Douglass,  22 
Doutrelepont,  519,  523 
Drysdale,  Thomas  M.,  43,  64 
Duhring,  534 

Duncan,  Matthews,  252,  465,  519,  520,527, 
657.  677,  688,  694,  695,  705,  722,  723. 
738' 

Dunglison,  588 
Dunlap,  A.,  27 
Duparque,  593,  641 
Duverney,  746 

E. 

Edis,  542,  568,  637 
Elischer,  175 
Ellinger,  433 
Ellis,  189,  198,  224,  231 
Emmet,  T.  A.,  34,  35,  36,  37,  41,  42,  43,  44, 
50,  54,  55,  63,  65,  199,  234,  252,  337, 
338,  530,  597,  667,  680,  699,  704,  707, 
714,  718,  720,  721,  722,  729,  738,  742, 
743,  750,  768 

Engelmann,  50,  141,  331,  387,  400,  403, 
409 

Erich,  499 
Eustache,  476 

F. 

Fallopio,  Gabriele,  87 
Farre,  169 
Fayrer,  525 
Fenger,  Christian,  55 
Fenwick,  Bedford,  529 
Finn,  646 
Fischel,  W.,  93 
Forster,  593 
Fort,  C.  H.,  263 

Foster,  Frank  P.,  102,  118,  228,  233.  234, 
362,  554,  698 
Foulis,  84,  93 
Franck,  737 

Frankenhauser,  146,  762 
Frarier,  709 
Freund,  708 


Frey,  121 
Friedlander,  141 

Fritsch,  154,  354,  561,  568.  688,  701,  707, 
716,727 

G. 

Galabin,  527,  653,  662 
Gallard,  735,  736,  737,  759,  761 
Gantillon,  377 

Garrigues,  56,  140,  192,  210,  228,  706,  719 

Gartner,  Herman  T.,  70,  93 

Geigel,  E.,  70,  93 

Gendrin,  377 

Gillette,  531 

Gilmour,  3S 

Giraldez,  75 

Girault,  475 

Goodell,  Wm.,  36,  40,  42,  50,  54,  58,  66, 
359,  433,  517,  530,  568,  617 
Goodman,  46 
Goupil,  687 
Graaf,  Begnier  de,  80 
Grandin.  Egbert  H.,  667 
Green,  T.  Henry,  536,  679 
Greenhalgh,  356 
Grobe,  236 
Gross,  26,431 

Guerin,  Alph..  217,  709,  715 
Gussenbauer,  109 
Gusserow,  155,  761 
Gurlt,  537 

H. 

ITadra,  B.  E.,  59 
Hagemann,  93 
Harrison,  738 

Hart,  D.  Berry,  682,  686,  724 
Hart  and  Barbour,  101,  106,  109,  112,  125, 
131,  132,  154,  167,  168,  188,  212,  222, 
227,  228,  229,  233,  568,  602,  638,  644, 
688,  708,  751,  761,  762,  764 
Heath,  224,  229 
Heath,  W.  H„  483 
Hedenius,  P.,  93 
Heear,  149,  578,  617 
Helie,  135,  137 

Henle,  121,  142,  172.  1S7,  188,  189,  230 

Hening,  137,  163,  169 

Hennig,  536,  56S,  582 

Heppner,  269 

Hermann,  107 

Herrick,  O.  E.,  56 

Herzfelder,  738 

Heschl,  600,  645,  746 

Hewitt,  Graily,  622,  654,  663,  73S  759 

Heyer,  738 

Heywood,  478 

Hicks,  Braxton,  694 

Hildebrandt,  498,  499,  515,  537,  539 

His,  W.,  94 

Hodge,  H.  L.,  29,  63,  599 
Hodgen,  487 
Hoggan,  643 
Holden,  187,  497 
Holyoke,  22 


AUTHORS’  INDEX. 


77b 


Howard,  Wm.  T.,  58 
Huguier,  113,  511,  736,  737,741 
Hunter,  33 
Hunter,  J.  B.,  56 
Hutchinson,  523,  527 
Hyatt,  H.  O.,  264 
Hyrtl,  198,  266,  516 


I. 

Ill,  J.  E„  444. 

Imbert,  G.,  94 


J. 

Jackson,  A.  Reeves,  39,  53,  536,  616 
Jacobi,  643,  644,  646,  647,  652 
Jacobi,  Mary  Putnam,  59,  410,  437,  602, 
638,  641,  647,  662 
Jacobson,  L.,  94 
Jenks,  Edward  W.,  52,  55,  513 


K. 

Kaltzenbach,  578 
Kammerer,  377,  454,  462 
Kaposi,  527 
Kaschkaroff,  660 
Ivehrer,  421,  441,  462,  617 
Kelly,  H.  A.,  58 
Kennedy,  536,  580 
Kerkring,  239 
Kidd,  580 

Kimball,  Gilman,  45,  61 
King,  John,  28 
Kirmisson,  534 

Kiwisch,  511,  542,  547,  599,  638 
Klebs,  268,  271,  738 
Klein,  121,  139,  142, 164,  172,  176,  190 
Klemm,  582 

Ivlob,  534,  539,  542,  546,  574,  599,  601, 
608,  637,  645,  649,  650,  660 
Ivobelt,  104,  109,  112 
Koch,  519,  523,  530 
Kocks,  J.,  71,  94 

Kolliker,  A.,  69,  73,  79,  83,  84,  85,  91,  94, 
237 

Konig,  219,  723 
Krause,  104 
Ivreiger,  738 
Kuhne,  766,  767 
Kundrat,  409 
Kussmaul,  247 
Kustner,  539 

L. 

Lallemand,  581 
Lamballe,  J.  de,  377 
Langenbeck,  242 
Langier,  737 

Langlade  and  Cummen,  239 

Lazarewitch,  655 

Le  Bee,  123,  131,  146,  687 

Lebeeleff,  261 

Lee,  C.  0.,  oo,  / 08,  / 40 


Lefort,  243 
Lenoir,  737 

Lente,  F.  D.,  39,  578,  581. 

Leopold,  129,  140,  141, 172,  409,  554,  643, 
644,  679,  680,  687 
Lever,  640 
Levy,  454 
Lewis,  W.,  63 
Lindgren,  142 
Lisfranc,  599,  638 
Lister,  165,  339 
Litzman,  443 
Lott,  141 
Louis,  261 
Lowenthal,  309 

Luschka,  102,  121,  132,  169,  186,  188,  193, 
221 

Lusk,  101,  107,  142,  492,  536,  651,  711,  713 
Lyman,  Geo.  H.,  28,  48,  731 


M. 

McCarthy*  Justin,  705 
i McClintock,  A.,  532,  677,  707,  711,728, 
735,  736,  738,  750,  752 
McCormick,  758,  768 
McDowell,  23,  29,  30 
Madge,  738,  740,  755,  762 
Mann,  Matthew  D.,  56,  127,  131,  334,  339 
Mapother,  447 
Marchal,  676,  677 
Marrotte,  761 
Marsh,  Howard,  727 
Martin,  648 

Martin,  Franklin  H.,  365,  617,  666 

Mason,  477 

Massot,  532 

Mayer,  243,  527,  538 

Meadows,  736,  738,  739,  742,  761,  769 

Meigs,  C.  D.,  29,  63,  502,  654 

Meniere,  405 

Meyer,  1L,  77,  94,  271 

Meyer,  Leopold,  236 

Miller,  Henry,  377,  581 

Milne,  Edwards  H.,  70,  94 

Minor,  Julius  F.,  3S 

Mitchell,  Weir,  610,  633 

Monod,  737 

Morel,  237 

Morris,  722 

Muller,  J.,  85 

Munde,  50,  53,  66,  250,  327,  398,  405,  443, 
444,  480,  528,  554,  561,  578,  666,  679, 
681 

N. 

Nandier,  710,  715 
Nega,  242 

Nelaton,  735,  736,  737,  745,  747 
Newman,  Robert,  61 
Nickles,  663 

Noeggerath,  E.,  37,  38,  45,  48,  431,  459, 
460,  571,  599,  608,  617,'  638,  660,  691 
Nona,  767 
I Nonat,  627,  677 


774 


AUTHORS’  INDEX. 


Nott,  J.  C.,  30,  377,  516,  518 
Is  y lander,  141 

O. 

Olshausen,  209,  23G,  617,  652,  713,  738,  765 

Oribasius,  676 

Orne,  22 

Osgood,  22 

Ott,  737 

P. 

Paget,  527,  552,  731 
Palfvn,  261 

Pallen,  Montrose  A.,  45,  443 
Palmer,  C.  D.,  35,  57 
Pare,  Ambroise,  22 
Parry,  John  S.,  39 
Parvin,  Theophilus,  38 
Pattee,  A.  F.,  62 
Paulus  JEgineta,  21 
Pauly,  742 

Peaslee,  36,  37,  64,  243,  245,  377 
Peuch,  737 

Peuch,  A.,  94,  236,  237,  255,  743 

Pfluger,  176,  409 

Phillips,  758 

Physick,  26 

Pick,  524 

Pirogoff,  212,  488,  683 
Playfair,  568,  580,  633 
Polk,  Wm.  M.,  56,  60,  192,  193,  210,  212, 
215,  682,  688,  698,  699,  717 
Pooley,  J.  H.,  261 
Post,  Alfred  C.,  58 
Post,  Sarah  E.,  60 

Poncet,  737,  740,  749,  751,  754,  756,  765, 
766 

Priestley,  542 
Prochownick,  239 
Prost,  737 
Puzos,  676 

Q. 

Quain,  94,  105,  107,  112,  136,  224 

R. 

Raciborski,  740 
Rainey,  159 

Ranney,  101,  102,  105,  108,  113,  131,  141, 
218,  228,  233 
Rasch,  759 
Recamier,  22,  30,  581 
Reinmann,  547 
Reyer,  525 
Richard,  476 
Richardson,  W.  L.,  719 
Richet,  740 
Ricard,  593 
Rieder,  Carl,  72,  94 
Rindfleisch,  748 
Ringer,  Sidney,  365,  562 
Robert,  737 
Robin,  C.  H.,  124,  707 
Rogers,  D.  L.,  27 
Rokitansky,  248,  546,  743 
Rose,  Cooper,  245 


I Rosenmiiller,  75 
Rouget,  139 
Routh,  477,  568 
Ruge  and  Veit,  143,  587 
Ruysch,  737 

S. 

Sanderson,  678 
Sanger,  536 

Savage,  98,  99,  108, 109,  121, 135.  140. 157, 
183,  186,  188,  189.  210,  226,  229,  684^ 
701,  723,  724 

i Scanzoni,  377,  516,  541 , 547,  568,  599,  637, 
641,  652,  661,  664,  722,  73S,  740,  745 ' 
Schafer,  216 

| Schroeder,  118,  354,  477,  480,  528,  542, 
568,  617,  644,  646,  654,  705,  722,  738. 
746 

Schuller,  180 
Schultz,  654 
Schultze,  718 
Schuppert,  M.,  38 
Schuregius,  515 
i Schwimmer,  524 
Scott,  John,  59 
Scultetus,  22 
Sedgwick,  86 
Serdukopf,  Ar.,  655 
Shatz,  F.,  94 
Silvestre,  749 

Simon,  29,  1S7,  617,  709,  710,  715 
Simpson,  A.  R.,  653,  724 
Simpson,  Jas.,  377,  511,  516,  536,  568,  637, 
638,  640,  641,  644,  646,  661,  664.  727. 
732,  738,  769 

Sims,  J.  Marion,  30,  34,  36,  37,  39.  45,  60, 
63,  475,  514 
Sinclair,  600 

Sinetv,  L.  de,  91,  94.  116,  117,  124.  125, 
140,  143,  167,  475,  587,  644.  647.  652 
Sircday,  752 

Skene,  Alex.,  46,  48,  65,  71,  94,  185,  1S8 

Smellie,  23 

Smith,  A.  G.,  27 

Smith,  N.,  27 

Smith,  Tyler,  568,  739 

Smyly,  759 

Spiegelberg,  607,  686,  6S8 
Stearns,  26 
Steurer,  706 

Storer,  H.  R.,  36,  3S,  63,  450 
j Strieker,  140 
I Stroinsky,  O.,  55 
Surgus,  Damien,  496 
Sussdorff,  322 


T. 

Tait,  Lawson.  169,  172,  180.  267.  409.  503, 
505,  509,  519,  688,  691,695,  701.  704. 
705,  722,  724,  729,  730,  73S,  742,  752. 
766,  769 

Taliaferro,  V.  A..  38 
Tardieu,  262.  741 

Taylor,  I.  E.,  28,  57,  241.  259,  519.  567 
Thin,  520,  527, 


AUTHORS'  INDEX. 


775 


Thomas,  T.  G.,  28,  36,  38,  49,  51,  54,  59, 
63.  118,  355,  486,  510,  518,  542,  567, 
568,  580,  599,  617,  638,  643,  660.  661, 
664,  677,  705,  710,  727,  732,  738 
Tilt,  738,  739 
Tripier,  396,  764,  765 
Trousseau,  562,  710,  742,  743 
Turner,  141 
Turnipseed,  E.  B.,  263 

U. 

Ulrich,  738 

V. 

Van  Buren,  Wm.  H.,  678 

Van  de  Warker,  E.,  51,  53,  132 

Veit,  723 

Velpeau,  677 

Vidal,  527,  582 

Vigues,  737 

Virchow,  237,  520,  527,  547,  675,  678,  701, 
705,  738,  741 

Voisin,  737,  738,  739,  743,  748,  751,  755 
Von  Haselberg,  583 
Von  Preuschin,  124 
Von  Recklinghausen,  706 


AV. 

Waklever,  W.,  68,  84,  86,  94,  172,  237,  270, 
678 

Walker,  H.  252 

Warren,  J.  C.,  27,  54 

Wassilieff,  M.,  72,  94 

Watts,  R.,  72 

Webster,  E.  II.,  340 

Wells.  Spencer,  168,  480,  742 

Wernick,  443 

West,  568,  677,  716 

White,  J.  C.,  523 

White,  J.  P.,  36,  37 

Whittaker,  J.  T.,  242 

Williams,  141,  144,  155,  409,  759 

Wilson,  Ellwood,  667,  672 

Wiltshire,  760 

Winckel,  T.,  94,  186,  236,  445.  461,  488, 
491,  497,  530,  537,  678,  723,  740 
Wolff,  Casper  Friedrich,  68 
Wunderlich,  694,  702 
Wylie,  G.,  135 

Z. 

Zweit'el,  515,  536,  538 


INDEX  TO  VOLUME  I 


A. 

Abdomen,  examination  of,  306 
inspection  of,  306 
mensuration  of,  307 
palpation  of,  307 

Abdominal  section  in  pelvic  peritonitis,  in- 
dications for,  7 04 

Abdomino-rectal  examination,  301 
Abortion,  treatment  of  hemorrhage  after, 
419 

Abscess,  chronic  pelvic,  56,  60 
pelvic,  721 
aspirating  sac,  731 
diagnosis  of,  726 
opening  sac,  728 
pathological  anatomy,  722 
sinuses,  732 
treatment  of,  727 
Acute  eczema  of  vulva,  503 
metritis,  546 

Adenitis,  periuterine,  680,  759 
Adeno-lymphangitis,  680,  759 
Adhesions,  pelvic,  treatment  of,  51-54 
Air,  fresh,  importance  of,  622 
Alcoholics,  use  of,  624 
Alexander’s  operation,  160 
Alopecia  of  vulva,  500,  501 
Amenorrhoea,  411 
electricity  in,  391 
treatment  of,  364,  413 
Amputation  of  cervix,  high,  150 
in  metritis,  617 
Anaesthesia  in  operations,  338 
Angeioleucitis,  680 
Angioma  of  vulva,  536 
AnteHexion.  cause  of  dysmenorrhcea,  423 
of  uterus,  256 
Antisepsis,  agents  for,  329 

in  gynecological  operations.  328 
Antiseptic  injections  in  childbed,  662 
Antiseptics  in  lupus,  523 
Anus,  fissure  of,  causing  dyspareunia,  453 
Apoplexy  of  ovary,  745 
Appendages,  uterine,  161 

disease  of,  complicating  dysmenor- 
rhoea,  420 

Applications,  intra-uterine,  agents,  381 
by  applicator  syringe,  578 
by  ingestion,  577 


Applications,  intra-uterine  method,  380 
topical,  in  endometritis,  559 
Applicator,  cotton-wrapped,  577 
hard  rubber,  564 
Sims’s,  580 

Applicator  syringe,  578,  5S1 
Arbor  vitse  uterina,  134,  137 
Arsenic,  use  of,  in  metritis,  612 
value  of,  372 
Arteries  of  ovaries,  179 
uterus,  143 

Artificial  impregnation,  475 
Aspermatism,  453 
Aspiration  for  diagnosis,  326 
Aspirators,  326 
Assistants  in  operations,  340 
Astringents  in  congestion,  563 
Atresia  ani  vaginalis,  261 
of  hymen,  262 
of  uterus,  253 
of  vagiua,  257,  458 
of  vulva,  267 
treatment  of,  478 
Atrophy  of  uterus,  599 
treatment  of,  618 

Auscultation  and  percussion  of  abdomen, 
306 

B, 

Bacillus  tuberculosis  in  lupus,  519 
Bartholin,  glands  of,  1 13.  (See  Vulvo-vaginal 
Gland.) 

Bathing  in  uterine  disease,  621 
Baths,  hip,  in  subinvolution,  663 
sun,  621 

Battey’s  operation,  39-49 
Battey  on  removal  of  ovaries,  39,  49 
Belladonna,  action  of,  370,  373 
Bimanual  examination,  method,  298 
Bladder,  anatomy  of,  gross,  188 
minute,  190 

diseases  of,  works  on,  65 
ligaments  of,  207 
relations  and  attachments,  191 
sphincter  of,  1S9 
supports  of,  225 
symptoms,  importance  of,  291 
Bleeding,  local,  in  chronic  metritis,  613 
Boils  on  vulva,  494 

J Bowels,  attention  to  function  of,  370,  626 

777 


INDEX  TO  VOLUME  I. 


Broad  ligaments,  207 
contents  of,  209 
in  pregnancy,  208 
Bromides,  value  of,  365,  374 
Bulb  of  ovary,  180 
Bulbs  of  vagina,  112 
of  vestibule,  112 
Bursting  cysts  of  abdomen,  54 
Buttle’s  spear,  613 
Buttonhole  incision  of  urethra,  54 

C. 

Cancer  as  a cause  of  metrorrhagia,  417 
of  cervix,  excision  fox',  62 
of  vulva,  537 

pelvic,  diagnosis  from  hsematocele,  761 
Cai'bolic  acid  in  dysmenorrhcea,  428 
Carcinoma  of  vulva,  539 
Caruncles  of  urethra  causing  dyspareunia, 
451 

electricity  in,  404 
Carunculse  myrtiformes,  118 
Cases,  rational  history  of,  284 
Catgut  for  sutures,  339 
Catheter,  passing  the,  115,  197 
Cedron  as  tonic,  369 
Cellulitis,  pelvic,  705 
diagnosis,  714 
from  fibroids,  718 
from  haematocele,  717 
electi'icity  in,  404. 
etiology,  706 
exudation,  seat  of,  715 
pathology,  708 
prognosis,  718 
pus  in,  710 
symptoms,  710 
lion-puerperal,  713 
puerperal,  711 
treatment  of,  60 
curative,  719 
prophylactic,  718 
remarks  on  treatment  of,  220 
Centennial  year,  46,  49 
Cervical  protector,  Wylie’s,  428 
Cervix,  amputation  of,  in  metritis,  617 
anatomy  of,  587 

appearances  of,  in  Sims’s  speculum,  314 
congestion  of,  glycerin  and  boro-gly- 
cerides in,  562 
cystic  degenei'ation  of,  591 
falsfe  ulceration  of,  587 
forcible  dilatation  of,  41.  (See  also 
Dilatation.) 

granular  degeneration  of,  589 
high  amputation  of,  150 
in  laceration,  149 
in  old  age,  149 

lacerations  of,  causing  subinvolution,  651 
operation  for  lacerated,  58 
history  of,  37 

pathological  anatomy  of,  588 
pelvic  peritonitis  following  operations 
upon,  698 

shape  and  size  of,  133 


Cervix,  stenosis,  dangers  of  incision  for, 
151 

syphilitic  ulceration  of,  593 
true  ulceration  of,  593 
Chadwick’s  table,  295 
Change  of  life,  436.  (See  Menopause.) 
Chloral,  use  of,  374 
Chromic  acid  as  application,  566,  580 
Chronic  eczema  of  vulva,  514 
metritis,  602 

hot  douche  in,  613 
quinine  in,  630 
sponge  tents  in,  616 
pelvic  abscess,  56,  60 
peritonitis,  696 
Clinic,  first  gynecological,  30 
Clitoris,  anatomy  of,  106 
attention  to,  necessai'y,  621 
hypertrophy  of,  447 
treatment,  477 
malformations  of,  266 
Cocaine,  use  of,  381 
Coccyodynia,  516 

causing  dyspareunia,  452 
Nott  on,  30 

Coccyx,  neuralgia  of,  516 
removal  of,  518 
Coflee,  use  of,  624 

Coitus  during  menstruation,  effects  of,  743 
excessive,  as  cause  of  subinvolution,  652 
hindrances  to,  from  malformations,  446 
impossible,  causes  of,  446 
painful,  448 

spasm  in,  fi-om  vaginismus,  515 
Colica  scortoi'um,  701 
Columbia  Hospital,  report  of,  41 
Condyloma,  examination,  298 
syphilitic,  of  vulva,  531,  534 
venereal,  of  vulva,  537 
Congestion,  use  of  astringents  in,  563 
Conjoined  examination,  298 
Connective  tissue,  pelvic,  215,  684 
continuity  of,  219 

practical  deductions  on  anatomy  of, 
219 

Constipation,  treatment  of,  390,  627 
Constitutional  treatment  of  chronic  uterine 
disease,  363,  619 

Constriction  at  os  internum,  152,  421 
Contraction  of  os,  561 
Corpus  luteum,  hemorrhage  from,  745 
Counter -indications  of  hot  douche,  559 
Course  of  chronic  metritis,  601 
of  subinvolution  of  uterus,  659 
Cowper’s  glands,  analogues  of,  113 
Cumulus  ovigerus,  83 
Cupping  the  uterus,  614 
Curette,  in  endometritis,  596 
forceps,  of  Emmet,  597 
Becamier’s,  596 
sharp,  use  of,  567 
Simon’s  spoon,  361,  597 
Sims’s,  latest  form  of,  41S 
Thomas’s,  360,  596 
used  for  diagnosis,  324 
varieties  of,  324 


INDEX  TO  VOLUME  I. 


779 


Curetting,  method  of,  598 
the  cervical  canal,  567 
Current,  electrical,  strength,  387 
Cyst  of  parovarium,  75 
of  round  ligament,  case  of,  4S8,  535 
Cystic  degeneration  of  cervix,  591 
Cystocele,  definition  of,  4S7 
Cystotomy,  126 

Cysts,  bursting,  of  abdomen,  54 
of  Gartner’s  canal,  72,  535 
of  round  ligament,  488 
case  of,  535 
of  vulva,  534 

of  vulvo-vaginal  gland,  534 
sebaceous,  of  vulva,  535 

I>. 

Dagget’s  examining-table,  296 
Decidua,  uterine,  140 
Defecation,  importance  of,  as  a symptom, 
292 

Denudation  in  plastic  operations,  346 
Depletion,  local,  562 

in  chronic  metritis,  613 
uterine,  value  of,  379 
Depressor,  Sims’s,  311 
Diagnosis,  artificial  prolapse  of  uterus  in, 
325 

gynecological,  283 
of  chronic  metritis,  606 
of  early  pregnancy,  149,  151 
of  endometritis,  chronic  cervical,  554 
corporeal,  574 
of  masturbation,  478 
of  pelvic  cellulitis,  705 
hsematocele,  757 
differential,  763 
from  cellulitis,  717 
from  hsematoma,  761 
haematoma,  766 
peritonitis,  697 
from  hsematocele,  759 
of  periuterine  inflammation,  658 
of  phlegmon  of  broad  ligament  from 
pelvic  hsematocele,  763 
of  retroflexion  of  gravid  uterus,  758 
of  sterility,  464 

of  subinvolution  of  uterus,  655,  659 
of  tumors  from  subinvolution,  658 
position  of  uterus  in,  300 
use  of  microscope  in,  327 
Diaphragm,  pelvic,  223 
Diet,  importance  of,  in  disease,  622 
Dietetics,  directions  for,  368 
Digestion,  attention  to,  625 
Digital  examination  in  left  lateral  position, 
310,  315 
method,  298 

Dilatation  of  cervix,  advantages  of  differ- 
ent methods,  357 
by  sounds,  359 
dangers  of,  359 
for  diagnosis,  319 
for  surgical  purposes,  354 
forcible,  41,  153 


Dilatation  of  cervix,  in  dvsmenorrhoea, 
427,  433 

Dilators,  uterine,  Emmet’s,  321 
Fritsch’s,  358 
Goodell’s,  319 
Hanks’s,  320 
Molesworth’s,  320,  322 
Nott’s,  358 
Palmer’s,  320,  560 
Peaslee’s,  559 
Schultze’s,  358 
Sims’s,  427 

Dimensions  of  uterus,  132,  152 
Diphtheritic  vulvitis,  492 
Discharge,  vaginal,  as  a symptom,  292 
Discus  proligerus,  83 

Disorders  of  menstruation,  electricitv  in, 
388 

Displacements  cause  subinvolution,  653 
genu-pectoral  position  in,  46,  129 
uterine,  electricity  in,  390 
Divulsion  in  dysmenorrhoea,  429 
Dorsal  position  in  examination,  297 
Double  uterus,  pregnancy  in,  252 
relation  to  superfoetation,  253 
vagina,  259 

Douche,  hot-water,  379,  414 
counter-indications,  559 
in  cervical  endometritis,  556 
in  chronic  metritis,  613 
in  endometritis,  545 
in  pelvic  peritonitis,  754 
indications,  558 
mode  of  use,  557 
Douglas,  folds  of,  210 
Douglas’s  pouch,  anatomy  of,  211 
boundaries  of,  683 
dangers  of  wounding,  127 
depth  of,  214 

intestines  in,  147,  212,  488 
Drainage  in  ovariotomy,  45 
Drainage-tubes,  Wylie’s  intra-uterine,  429 
Dress,  importance  of  attention  to,  621 
rules  for,  610 
Ducts,  Gartner’s,  70 
Mullerian,  85 
Skene’s,  71 
Wolffian,  68 

Duverney,  glands  of,  113.  (See  Vulvo- 
vaginal. ) 

Dysmenorrhoea,  419 
caused  by  retroflexion,  423 
causes  of,  421 
classes  most  liable  to,  424 
complications  of,  420 
divulsion  in,  429 
electricity  in,  390 
forcible  dilatation  in,  433 
glycerin  and  boro-glycerides  in,  426 
membranous,  434 
pessaries  in,  434 
treatment  of,  425 
by  dilatation,  427 
by  divulsion,  429 
by  sounds,  433 
by  sponge  tents,  433 


780 


INDEX  TO  VOLUME  I. 


Dyspareunia,  causes  of,  448-452 
caused  by  lacerations  of  cervix,  458 

E. 

Eczema  of  vulva,  503 
chronic,  514 

Electrical  current,  dangers  from,  in  extra- 
uterine  pregnancy,  406 
strength  of,  387 

in  extra-uterine  pregnancy,  406 
in  uterine  fibroids,  402 
Electricity,  in  amenorrhoea,  391,  414 
in  chronic  pelvic  inflammation,  404 
in  diseases  of  menstruation,  388 
in  dysmenorrhoea,  390 
in  extra-uterine  pregnancy,  405,  406 
in  fibroid  tumors,  399 
in  hyperplasia  uteri,  404 
in  menorrhagia,  391 
in  ovarian  tumors,  398 
in  ovaritis  and  ovarian  neuralgia,  393 
in  periuterine  hematocele,  397 
in  subinvolution  of  uterus,  393 
in  subinvolution  of  vagina,  672 
in  superinvolution  of  uterus,  395 
in  uterine  displacements,  396 
in  uterine  stenosis,  405 
note  on  use  of,  632 
use  of,  in  gynecology,  373,  383 
Electrization,  localized,  method  of,  385 
Electrodes,  covering  of,  387 
size  of,  388 

Electrolysis  in  fibroids,  399 
electrodes  in,  404 
in  ovarian  cysts,  50 
pain  in,  401 
results  in,  403 
strength  of  current  in,  402 
Elephantiasis  Arabum,  524 
distinguished  from  fibroma  difiusum,  527 
Emmenagogues,  366,  414 
Emmet’s  needle-holder,  348 
operation,  invention  of,  37 
Enehondroma  of  vulva,  536 
Endocervicitis,  silver  nitrate  in,  564 
use  of  zinc  in,  565 
Endometritis,  acute,  541 

as  a cause  of  subinvolution,  652 
caused  by  gonorrhoea,  542 
chronic,  548 
cervical,  549 
cause,  551 
complications,  554 
diagnosis,  554 
frequency,  549 
hot  douche  in,  556 
pathology,  550 
physical  signs,  553 
prognosis,  555 
symptoms,  552 
treatment,  555,  560 
corporeal,  56S 
cause,  570 
diagnosis,  574 
frequency,  568 


Endometritis,  chronic  corporeal,  pathol- 
ogy, 569 
prognosis,  575 
symptoms,  572 
treatment,  575 
ingestion,  577 
local  method,  577 
general,  568 
fungoid,  574 
curette  in,  596 
hot  douche  in,  545,  556 
septic,  545 
silver  nitrate  in,  581 
Enucleation  of  fibroids,  44,  45 
of  pedicle,  38 
Epispadias,  265 
treatment  of,  477 
Epithelioma  of  vulva,  537 
Erectile  organs  of  female,  10S 
Ergot,  action  of,  on  sexual  organs,  371 
discovery  of,  26 
in  uterine  fibroids,  45 
Erysipelas  of  vulva,  504 
Erythema  of  vulva,  503 
Esthiomene,  518 

Etiology  of  chronic  metritis,  602 
of  dysmenorrhoea,  421 
of  dyspareunia,  448. 
of  pelvic  cellulitis,  706 
hematocele,  73S 
hematoma,  765 
peritonitis,  690 

of  periuterine  inflammation,  677 
of  sterility,  467 
of  subinvolution  of  uterus,  649 
of  vagina,  669 
Examination,  bimanual,  298 
digital  in  dorsal  position,  298 
in  erect  position,  316 
in  genu-pectoral  position,  316 
in  left  lateral  position,  310,  315 
in  Sims’s  position,  310 
dorsal  position  in,  297 
in  diagnosis,  296 
in  sterility,  466 
of  abdomen,  306 
of  rectum,  318 
rectal,  301 

recto-abdominal,  301 
specular,  304,  313 
vaginal,  method  of,  29S 
vesico-rectal,  302 
Examining-tables,  294 
Excision  of  cervix  for  cancer,  62 
Exercise,  importance  of,  620 
Exploration,  rectal,  29 
External  genitals,  anatomy  of,  96 
os,  133 

Extra-uterine  pregnancy,  cause  of  liamia- 
tocele,  746 

dangers  from  electrical  current  in,  406 
distinguished  from  hematocele,  759, 
763 

electricity  in,  405,  406 
operations  for,  28 
Exudation  in  pelvic  cellulitis,  715 


INDEX  TO  VOLUME  I. 


781 


F. 

Fallopian  tubes,  anatomy  of,  161 
catarrh  of,  163 
development  of,  87 
hemorrhage  from,  642,  746 
malformations  of,  237 
mucous  membrane  of,  164 
permeability  by  fluids,  582 
by  probe,  152 
Faradization,  general,  384 
Fecundation,  conditions  of,  441 
Fibroid  tumors  cause  hemorrhage,  416 
of  uterus,  electricity  in,  399 
uterine,  removed  through  anterior  vag- 
inal wall,  56 

Fibroids  diagnosed  from  cellulitis,  718 
from  hasmatocele,  761,  763 
electricity  in,  60 
of  uterus,  enucleation  of,  44 
removed  by  laparotomy,  57 
Fibroma  and  fibro-myoma  of  vulva,  529 
diffusum  of  vulva,  526 
Fibrous  tumors  of  uterus,  Atlee  on,  28 
Fissure  of  vulva,  494 

of  anus,  causing  dyspareunia,  453 
Fistula,  artificial  vesico-vaginal,  history 
of,  34 

in  ano,  operation  for,  55 
urethro-vaginal,  Parvin's  operation  for, 
3S 

vesico-vaginal,  history  of,  30 
operation  for,  30,  50 
Floor,  pelvic,  anatomy  of,  222 
Follicular  vulvitis,  492 
Food,  care  in  diet,  622 
value  of,  in  pelvic  disease,  369 
Forceps,  tissue,  345 
twisting,  for  wire,  352 
vulsellnm,  342,  349 

Forcible  dilatation  in  dysmenorrhcea,  433 
Formulae  for  constipation,  629 
for  pruritus  vulvse,  508 
for  tonics,  626,  631 
Fourchette,  anatomy  of,  102,  105 
Fungoid  degeneration  of  endometrium,  594 
Fungosities,  uterine,  594 
Furunculosis  vulvse,  494 

G. 

Galvanometer,  necessity  for,  387 
Gangrene  of  vulva,  496 
Gartner’s  ducts,  70,  181 
Gaseous  tumor  of  vulva,  536 
Genu-pectoral  position  for  displacements, 
46,  129 
Geodes,  139 

Gestation,  incapacity  for,  461 
treatment,  472 
Giraldez’s  body,  75 

Gland,  Skene’s,  of  urethra,  71,  180,  185, 
796 

of  Bartholin.  (See  Vulvo-vayinal  Gland.) 
vulvo- vaginal,  catarrh  of,  499 
Glands,  utricular,  140 


Glycerin  and  boro-glycerides  in  dysmenor- 
rhoea,  426 
to  vagina,  414 
as  a depleting  agent,  380 
in  chronic  metritis,  615 
in  congestion  of  cervix,  562 
Gold,  chloride  of,  action  of,  372 
Gonorrhcea,  cause  of  endometritis,  542 
pelvic  inflammation,  691 
warts  of  vulva,  536 
latent,  48,  691 

cause  of  sterility,  460 
Gonorrhoeal  vulvitis,  492 
Graafian  follicles,  anatomy  of,  17 6 
development  of,  82 
Gravid  uterus,  injuries  of,  55 
j Granular  degeneration,  like  cancer,  590 
Greek  gynecology,  review  of,  18 
Gutheris’s  muscle,  186 
Gymnastic  exercises,  value  of,  376 
Gynecological  diagnosis,  283 
examining-table,  294 
Society,  American,  46,  64 
Gynecology,  chairs  of,  66 
first  American  article  on,  22 
history  of,  17 
works  on,  63,  65,  66 

H. 

Haematocele  and  haematoma,  736 

caused  by  extra-uterine  pregnancy,  746 
distinguished  from  extra-uterine  preg- 
nancy, 759 
first  essays  on,  38 
pelvic,  735 

bloody  urine  in,  754 
boundaries  of  sac,  748 
causes,  738 
contents  of  sac,  749 
contrast  with  haematoma,  748 
diagnosis,  757 

from  cellulitis,  717 
from  haematoma,  761 
of  source  of  blood,  760 
differential  diagnosis,  table,  763 
history,  737 

mobility  of  uterus  in,  759 
pathology,  743 
symptoms,  750 
temperature  in,  750 
termination  of,  755 
tumor  in,  754 

ulceration  of  cyst-wall,  756 
peritonitis  following,  747 
periuterine,  electricity  in,  397 
Haematoma  of  ovary,  case  of,  749 
of  vulva,  497 
pelvic,  764 
anatomy,  764 
causes,  765 
diagnosis,  766 
prognosis,  766 
symptoms,  766 
treatment,  767 
Haemostatics,  418 


782 


INDEX  TO  VOLUME  I. 


Hair,  inversion  of,  on  labia,  502 
Headache,  treatment  of,  634 
Hemorrhage  after  abortion,  treatment  of, 
419 

from  corpus  luteum,  745 
from  Fallopian  tubes,  642,  746 
from  vulva,  115 
Heredity,  importance  of,  286 
Hermaphrodism,  267 

case  of  Carl  Hohmann,  273 
spurious,  277 
Hernia,  inguinal,  482 
labial,  anterior,  482 
perineal,  487 
pudendal,  486 
uterine,  257 
vaginal,  483 
ventral,  60 
Herpes  of  vulva,  502 
History  of  gynecology,  17 
rational,  of  cases,  284 
Hohmann,  C.,  the  hermaphrodite,  273 
Hook,  counter-pressure,  349 
Hot-water  douche.  (See  Douche.) 

Hot  water,  history  of  use  of,  61 
Hottentot  apron,  267 
Houston,  valve  of,  267 
Hydatids  of  Morgagni,  238 
Hydrocele,  488 

case  of  forming  large  cyst,  535 
Hymen,  anatomy  of,  117 
atresia  of,  262 
development  of,  92 
examination  of,  125 
forms  of,  118 
malformations  of,  262 
medico-legal  importance  of,  118 
of  negro  race,  263 
resisting,  447 

Hyoscine,  hydrobromate  of,  373 
Hypersemia,  uterine,  599 
Hyperesthesia  of  vulva;  cause  of  dyspa- 
reunia,  450 

Hyperplasia,  areolar,  of  uterus,  599 
electricity  in,  404 
Hypertrophy,  uterine,  599 
of  clitoris,  447 
treatment,  477 
Hypospadias,  265 
treatment  of,  477 

Hysterectomy,  vaginal,  position  for,  128 
Hystero-neurosis,  50 

I. 

Ice,  use  of,  after  operations,  333 
Impregnation,  artificial,  475 
Incontinence  of  urine  after  dilatation  of 
urethra,  196 

Induration,  pelvic  treatment  of,  51 
Inflammation  of  vulvo-vaginal  gland.  500 
Inflammatory  exudations,  cause  of  dyspa- 
reunia,  451 
Inguinal  hernia,  482 
Injections,  intra-uterine,  582 
of  hot  water.  (See  Douche.) 


Injections,  parenchymatous,  616 
Injuries  and  wounds  of  vulva,  479 
Insemination,  incapacity  for,  442 
Inspection  of  abdomen,  306 
of  vulva,  297 

Instruments,  mode  of  cleaning,  330 
operating,  340 

Intercourse,  sexual.  (See  Coitus.) 

Internal  os,  134 
Intra-uterine  applications,  381 
injections,  582 
counter-indications,  585 
to  prevent  dangers  of,  584 
medication,  578.  (See  also  A pplications. ) 
Lente  on,  39 
value  of,  377 
medicator,  Palmer’s,  579 
Wylie’s,  428 

scarification,  knife  for,  614 
Inversion  of  inverted  uterus,  operation 
for,  57,  62 

Inverted  uterus,  reduction  of,  by  White 
and  others,  37 

Iodine,  Churchill’s  tincture  of,  564 
in  chronic  metritis,  615 
Iodized  phenol,  580 
Iodo-tannin,  564 
Iron  as  a tonic,  364 

in  chronic  metritis,  612 
Irrigation,  antiseptic,  in  operations,  330, 
331 

of  uterus,  332 

J. 

Journal  of  Obstetrics,  A merican,  63 

Iv. 

Knife,  Emmet’s  ball-and-socket,  345 
for  scarification,  614 
Ivolpo-hyslerectomv,  first  case  of,  55 

L. 

Labia,  hvpertrophv  of,  obstacle  to  coitus, 
447 

inversion  of  hair  of,  502 
majora,  anatomy  of,  9S 
anatomy,  gross,  of,  100 
minute,  of,  101 
minora,  anatomy  of,  101 
arteries  of,  104 
malformations  of,  266 
treatment  of  hypertrophy  of,  477 
oozing  tumor  of,  531 
Labial  hernia,  anterior.  482 
Lacerations  of  cervix,  cause  of  dyspareu- 
nia,  450 

cause  of  subinvolution,  651 
operation  for,  43 
Laparo-elytrotomy,  46,  56 
Latent  gonorrhoea,  48,  691 
Lateral  displacement  of  uterus,  148 
I Left  lateral  position,  description  of,  30S 
digital  examination  in,  310 


1XDEX  TO  VOLUME  I. 


783 


Left  lateral  position,  objections  to, 
309 

speculum  in,  310 
Leptothrix  vaginalis,  500 
Levator  ani  muscle,  220 
spasm  of,  515 

Ligament,  infundibulo-pelvic,  79 
Ligaments,  round,  157 
of  bladder,  207 
saero-uterine,  feel  of,  127 
uterine,  213 
anatomy  of,  207 
support  the  uterus,  221 
Ligatures,  silk,  mode  of  cleaning,  330 
Lipoma  of  vulva,  530 
Literature,  lists  otj  93,  278.  tSee  note  in 
Index  of  Authors  for  other  pages,  i 
Local  treatment  of  uterine  disease,  370 
Lupus,  antiseptics  in,  523 
bacillus  tuberculosis  in,  519 
of  vulva,  518 
perforans,  521 
prominens,  521 
serpiginosus,  521 
treatment  of,  523 
Lymphangitis,  adeno-,  080.  759 
Lymphatics  of  uterus,  anatomy  of,  139,  0S6 

M. 

Malformations,  hindrances  to  coitus,  410 
of  clitoris,  260 
of  hymen,  262 
of  ovaries,  235 
of  uterus,  23S 
of  vagina,  257 
of  vulva,  264 
Massage,  general,  632 
uterine,  53,  616 
value  of,  375 

Masturbation,  diagnosis  of,  478 
Melanoma  of  vulva,  536 
Membrana  granulosa,  formation  of,  84 
Membranous  dysmenorrhcea,  431 
pathology,  435 
treatment,  435 
Menopause,  436 
symptoms  referred  to,  293 
treatment  of,  437 
Menorrhagia,  electricity  in,  391 
theory  of,  4S 

Menstruation,  absence  of,  411 
disorders  of,  electricity  in,  38S 
excessive,  115 
normal,  108 
theories  of,  409 
painful,  419 
questioning  about,  287 
scanty,  413 
theory  of,  59 
vicarious,  415 

Mensuration  of  abdomen,  307 
Mental  disease  due  to  sexual  disease,  50 
Mercury,  action  of,  on  disease  of  sexual 
organs.  372 

Mesosalpinx,  development  of,  79 


Mesovarium,  development  of,  77 
Metritis,  acute,  516 
chronic,  causes,  002 
diagnosis,  006 

glycerin  and  boro-glvceride  in, 
*615 

iron  in,  612 
parenchymatous,  599 
quinine  in,  630 
sponge  tents  in,  616 
stages  of,  601 
symptoms,  605 
treatment,  609 
general,  610 
special  medication,  611 
varieties,  601 

Metrorrhagia,  cancer  as  cause  of,  417 
curetting  in.  418 
fibroids  as  cause  of,  416 
treatment  of,  417 
Microscope  in  diagnosis,  327 
Mineral  waters,  value- of,  010,  627 
Mitchell’s,  Weir,  treatment,  610,  633 
Mons  Veneris,  anatomy  of,  97 
Moral  treatment,  635 
Morgagni,  columns  of,  198 
hydatids  of,  238 

Mucous  membrane,  uterine,  110 
of  cervix,  142 
of  the  new-born,  91 
of  uterus,  136,  110 
Mullerian  ducts,  development  of,  85 
Muscles,  levator  ani,  220 
of  pelvic  floor,  225 
of  perineum,  230 
Myoma  of  vulva,  529 
Myrtiform  caruncles.  118 
Myxoma  of  vulva,  530 

X. 

Needle-holder,  Emmet’s,  34S 
Needles,  mode  of  use,  317 
varieties  of,  347 
Negro  race,  hymen  of,  263 
Nerve-sedatives,  372 
Nerve-tonics,  364,  372 
Nerves  of  clitoris,  109 

and  vessels  of  perineum,  232 
of  uterus,  143,  155 
of  uterus,  140,  142,  146 
of  vagina,  124 
of  vulva,  100 

Nervousness,  treatment  of,  634 
Neuralgia  of  coccyx,  516 
ovarian,  electricity  in,  393 
Neuroma,  case  of.  causing  dvspareunia, 
452 

of  vulva,  536 

New  growths  of  vulva,  518 
Nitrate  of  silver  within  the  uterus,  5S1 
Nitric  acid  as  application,  565,  5S0 
Nuck,  canal  of,  158,  160,  236 
cyst  in,  488 

Nymphse,  anatomy  of,  101.  (See  Labia 
Minora.) 


784 


INDEX  TO  VOLUME  I. 


O. 

Obstetric  Gazette,  65 
CEderna  of  vulva,  75,  495 
O'idium  albicans,  cause  of  pruritus,  506 
Ointments  for  intra-uterine  use,  581 
Oozing  tumor  of  labia,  531 
Operation  for  lacerated  cervix,  58 
for  perineal  rupture,  54,  55,  59,  234 
for  retroversion,  56 
Operations  during  pregnancy,  334 
plastic,  346 

preparatory  treatment,  336 
two  at  once  safe,  385 
when  to  be  done,  333 
Opium  in  pelvic  inflammation,  374 
use  of,  in  operations,  333 
Orgasm,  effect  on  uterus,  443 
Os,  contraction  of,  561 
external  os  tincse,  133 
internum,  134 
Osteoma  of  vulva,  536 
Ova,  formation  of,  80 
number  of,  84 
Ovarial  tubes,  174 
Ovarian  corpuscle,  Drysdale’s,  43 
disease  and  dysinenorrhoea,  419 
neuralgia,  electricity  in,  393 
tumors,  diagnosis  from  haunatocele,  7-: 
electricity  in,  398 
works,  writers  on,  64 
Ovaries,  absence  of,  236 
anatomy  of,  107 
gross,  169 
minute,  172 
blood-supply  of,  179 
color  of,  169 
descent  of,  78 
development  of,  76 
indications  for  removal  of,  40 
malformations  of,  236 
position  of,  1 67 

practical  deductions  from  anatomy  c 
181 

prolapse  of,  53 

relations  and  attachments  of,  168 
to  the  tubes,  79 
removal  of,  Battey  on,  39,  49 
rudimentary,  237 
size  of,  in  children,  85,  169 
supernumerary,  236 
Ovariotomist,  McDowell  the  first,  24 
Ovariotomists,  early  American,  27 
Ovariotomy,  drainage  in,  45 
euneleating  the  pedicle  in,  38 
high  temperature  after,  5 1 
Lyman  on,  28 
septicaemia  following,  37 
vaginal,  40,  50 
Thomas  on,  38 
Ovaritis,  electricity  in,  393 
Ovary,  apoplexy  of,  745 
bulb  of,  180 

epithelium  covering,  172 
hsem  atom  a of,  749 
prolapse  of,  37, 181 


Ovary,  prolapse  of,  in  dyspareunia.  451 
Oviducts.  (See  Fallopian  Tabes.) 

Ovula  Nabothii,  143 
Ovule,  non-maturation  of,  459 
obstruction  to  passage  of,  461 
Ovulation,  incapacity  for,  458 
Ovum,  anatomy  of,  177 
primordial,  84 

P. 

Pachydermia  of  vulva,  524 
Pachysalpingitis,  167 
Packing  the  vagina,  53 
Pain  as  symptom  of  uterine  disease,  259 
Palpation  of  abdomen,  307 
Papilliform  plexus,  180 
hemorrhage  from,  745 
Papilloma  of  vulva,  530 
Paradidymis,  76 
Parametritis  (see  Cellulitis),  705 
Parenchymatous  metritis,  chronic,  599 
Parotitis  following  operations  on  genitals, 
58 

Parovarian  cyst,  cause  of,  7 5 
Parovarium,  75,  180 

Pathology  of  endometritis,  chronic  cer- 
vical, 550 

chronic  corporeal,  569 
of  membranous  dysinenorrhoea.  435 
of  pelvic  cellulitis,  70S 
hsematocele,  743 
peritonitis,  689 

of  subinvolution  of  vagina,  668 
Pedicle,  enucleating  the,  38 
Pediculosis  pubis,  505 
Pelvic  abscess.  (See  Abscess.) 
chronic,  56,  60 
cellulitis,  electricity  in,  404 
pus  in,  710 
exudation  in,  715 
connective  tissue,  anatomy  of,  215 
disease,  physical  signs  of,  293 
effusions,  Brickell  on,  49 
floor,  anatomy  of,  222 
muscles  of,  225 
physics  of,  233 
projection  of,  234 
spasm  of  muscles  of,  511 
lnvmatoma,  764 
induration,  treatment  of.  51 
inflammation  caused  bv  gonorrhoea,  691 
use  of  opium  in,  374 
peritoneum,  anatomy  of,  204,  682 
peritonitis,  687 

complicating  dysinenorrhoea,  420 
electricity  in,  404 
hot  douche  in,  754 
sinuses  from  abscess,  732 
vessels,  enlargement  of,  156 
obstructions  in,  155 
Pencils,  gelatin,  563 
Perimetritis  (see  Peritonitis.  Pelric),  68< 
Perineal  body,  anatomy  of,  22S 
function  of,  233 
hernia,  487 


INDEX  TO  VOLUME  I. 


785 


Perineal  rupture,  operation  for,  54,  55,  59, 
234 

Perineorrhaphy,  Jenks  on,  52 
Perineum,  229 

failure  in  operations  for  rupture  of,  42 
muscles  of,  230 
nerves  and  vessels  of,  232 
primary  operation  for  rupture  of,  481 
rupture  of,  operation  for,  42,  54,  55,  59, 
234 

veins  of,  103 
Peritoneum,  pelvic,  6S2 
anatomy  of,  204,  682 

changes  in  pregnancy,  206 
folds  of,  207 

Peritonitis,  encysted  tubercular,  58 
hsemorrhagica,  741 
following  haematocele,  747 
pelvic,  687 

abdominal  section  in,  704 
cause  of,  690 
chronic  form,  696 

common  form  of  pelvic  inflammation, 
700 

complicating  dysmenorrhoea,  420 
diagnosed  from  hoematoeele,  759 
diagnosis,  697 
electricity  in,  404 
exacerbations  in,  695 
following  operations  on  cervix,  698 
minor  forms,  698 
pathology  of,  689 
physical  signs,  696 
prognosis,  701 
septic  form  of,  694 
symptomatology,  693 
treatment,  702 
tumors  in,  606 
tubercular,  58,  692 

Periuterine  adenitis  and  angeioleucitis,  680 
luematocele,  electricity  in,  397 
inflammation,  675 
definition,  675 
diagnosis,  658 
etiology,  677 
history,  675 

Permanganate  of  potash,  365 
Pessaries,  invention  of,  62 
in  dysmenorrhoea,  434 
Pessary,  Hodge’s  invention  of,  27 
Phenol,  iodized,  580 

I'lilegmon  of  broad  ligament.  (See  Cel- 
lulitis.) 

diagnosed  from  pelvic  luematocele, 
763 

Phlegmonous  vulvitis,  493 
Phosphates  as  nerve-tonics,  364 
Phosphorus,  use  of,  373 
Physical  signs  of  pelvic  disease,  293 
Pityriasis  versicolor  of  vulva,  504 
Placenta,  retained,  causing  subinvolution, 
653 

Plicae  palmata?,  137 
Plica  urogenitalis,  68 
Position,  dorsal,  297 
erect,  examination  in,  316 
Vol.  I. — 50 


Position,  genu-pectoral,  examination  in, 
315 

in  gynecological  diagnosis,  296 
left  lateral,  examination  in,  310 
of  uterus  in  diagnosis,  300 
Post-partum  hemorrhage,  causing  subinvo- 
lution, 653 

Practical  deductions  on  anatomv  of  ovaries, 
181 

of  pelvic  connective  tissue,  219 
of  pelvic  peritoneum,  213 
of  rectum,  202 
of  urinary  organs,  193 
of  uterus,  147 
of  tubes,  165 
of  vagina,  125 
of  vulva,  114 
Precocity,  239 

Pregnancy,  early  diagnosis  of,  149,  151 
in  double  uterus,  252 
operations  during,  334 
treatment  of  cervix  during,  567 
tubal,  56 

Preparatory  treatment  to  operations,  336 
Primordial  ovum,  84 
Probe,  Emmet’s  flexible,  315 
introduction  of,  315 

Prognosis  of  endometritis,  chronic  cervi- 
cal, 555 

chronic  corporeal,  575 
of  pelvic  cellulitis,  718 
hsematoma,  766 
peritonitis,  701 
of  sterility,  468 

Prolapse,  artificial,  of  uterus  for  diagnosis, 
325 

of  ovary,  53,  181 
Sims’s  operation  for,  37 
Prurigo  of  vulva,  503 
Pruritus  of  vulva,  505 
treatment  of,  507 
caused  by  oidium  albicans,  506 
Pudendal  hernia,  486 
sac,  230 

IJudendum.  (See  Vulva.) 

Pus  in  pelvic  cellulitis,  710 

Q- 

Quinine,  use  of,  373 

after  operations,  333 
in  chronic  metritis,  630 
in  menstrual  disorders,  367 

R. 

Rectal  examination,  methods,  of,  301 
Simon’s  method  of,  302 
exploration,  29 
by  eversion,  38 
Rectocele,  definition  of,  487 
Rectum,  anatomy  of,  197 
gross,  198 
minute,  250 
examination  of,  318 

practical  deductions  on  anatomy  of,  202 


786 


INDEX  TO  VOLUME  I. 


Kectum,  relations  and  attachments  of,  201 
sphincter  of,  199 
symptoms,  importance  of,  291 
Remedies  acting  on  pelvic  organs,  classifi- 
cation of,  368 

Rest  as  a therapeutic  agent,  619 
Retroflexion  as  cause  of  dvsmenorrhcea, 
423 

of  gravid  uterus,  diagnosis,  756 
Retroversion,  operation  for,  56 
Roman  gynecology,  history  of,  20 
Rosenmiiller’s  organ,  75 
Round  ligaments,  cyst  of,  488,  535 
of  uterus,  157 
Rudimentary  uterus,  242 
Rupture.  (See  Hernia.) 

of  perineum,  failure  in  operation  for,  42 
operation  for,  54,  55,  59,  234 

S. 

Sarcoma  of  vulva,  537 
Scarification,  knife  for,  614 
Scissors,  Emmet’s,  344 
Sclerosis,  uterine,  599 
Sebaceous  cysts  of  vulva,  535 
Sedatives,  nerve,  372 
Semen  without  spermatozoa,  453 
Senile  changes  in  vagina,  120 
Septic  wounds,  treatment  of,  332 
pelvic  peritonitis,  694 
Septicaemia  following  ovariotomy,  37 
Serpiginous  vascular  degeneration,  509 
Sexual  sense  in  women,  444 
Shield,  Sims’s,  352 

for  twisting  sutures,  352 
Silk  for  sutures,  339 

ligatures,  mode  of  cleaning,  330 
Silver  nitrate  in  endocervicitis,  564 
in  endometritis,  581 
suture,  invention  of,  33 
sutures,  339 

application  of,  348 
shouldering  of,  351 
twisting  of,  351,  352 
Simon’s  speculum,  341 
spoon  curette,  361,  597 
Simpson’s  sound,  302 
use  of,  303 

Sims’s  depressor,  311 
position,  description  of,  308,  340 
sharp  curette,  old  model,  597 
shield,  352 

speculum,  objections  to,  310 
tenaculum,  314 
Sinus,  urogenital,  69,  88,  89 
Sinuses,  pelvic,  from  abscess,  732 
Skene,  glands  of,  in  urethra,  71,  180,  185, 
796 

Skin  diseases  of  vulva,  501 
Societies,  gynecological,  66 
Solid  uterus,  242 
Sound,  best  form  of,  302 

care  in  use  of,  in  pelvic  liaematocele,  753 
Simpson’s,  302 
the  uterine,  302 


Sounds,  graduated,  357 
Spasm  of  muscles  of  pelvic  floor,  511 
Spear,  Buttle’ s,  for  cervix,  613 
Specula,  cylindrical  and  plurivalve,  304 
Speculum,  Brewer’s,  305 
Fergusson’s,  305 
Hunter-Erich’s,  310 
invention  of,  20-22 
Mann’s,  312 
Munde’s,  313 
Nott’s,  306 
Simon’s,  341 

Sims’s,  advantages  of,  306,  311,  340 
invention  of,  31 
mode  of  use,  313,  340 
Spermatozoa,  absence  of,  in  semen,  453 
destruction  of,  in  cervix,  454 
impediments  to  progress  of,  455 
mode  of  entry  into  uterus,  43 
progress  of,  445 
Sphincter  recti,  199 
of  bladder,  189 
of  urethra,  186 
third,  198 
uteri,  135 

Sponge-holder,  Sims’s,  343 
Sponges,  mode  of  cleaning,  330 
Spoon,  Simon’s  sharp,  361,  597 
Spurious  hermaphrodism,  277 
Stem,  intra-uterine,  for  drainage,  Wylie’s, 
429 

Stenosis  of  cervix,  dangers  of  incision  for, 
151 

uteri,  electricity  in,  405 
Sterility,  441 

abnormal  conditions  of,  463 

caused  by  latent  gonorrhoea,  460 

diagnosis  of,  464 

examination  in,  466 

hidden  causes  of,  467 

prognosis,  46S 

subjective  symptoms  of,  462 

table  of  abnormal  conditions  in,  463 

treatment,  468 

Strychnia,  value  of,  as  a tonic,  364 
Subinvolution,  electricity  in,  393 
non-puerperal,  601 
operations  on  vagina  in,  673 
of  uterus,  599,  637 
caused  by  tumors,  652 
course  and  results,  659 
diagnosis,  655 

diagnosis  from  chronic  metritis,  659 
differentiation,  657 
etiology,  649,  653 
exciting  causes  of,  650 
histology,  642 
history  of,  63S 
local  treatment,  664 
mechanical  treatment,  666 
operative  treatment,  666 
physical  signs  656 
symptoms  of,  655 
treatment,  661 
of  vagina,  667 
cause,  669 


INDEX  TO  VOLUME  I. 


787 


Subin  volution  of  vagina,  pathology,  668 
treatment,  671 

post-partum  hemorrhage  causing,  653 
Sun-baths,  621 

Superfcetation,  relation  of,  to  double  uterus, 
253 

Superinvolution,  electricity  in,  395 
Supports  of  (he  uterus,  221,  534 
of  bladder,  225 

Sutures,  materials  for,  338,  339 
removal  of,  353 
Symptoms,  importance  of,  288 
of  chronic  metritis,  605 
of  pelvic  peritonitis,  693 
of  sterility,  subjective,  462 
of  subinvolution  of  uterus,  655 
Syphilitic  ulceration  of  cervix,  593 
condyloma  of  vulva,  534 
warts  of  vulva,  534 
Syringe,  applicator,  581 

T. 

Table  of  abnormal  conditions  in  sterility, 
463 

of  differential  diagnosis  of  pelvic  hsenia- 
tocele,  763 
operation,  337 

Tables,  gynecological  examining-,  294 
Tampon,  lampwick  for,  362 
vaginal,  361 

Temperature,  high,  after  ovariotomy,  51 
Tenaculum,  Emmet’s,  314 
double,  342 
Mann’s,  312 
operating,  345 
self-retaining,  577 
Sims’s,  314 

Tents  in  treatment  of  endometritis,  560 
laminaria,  321,  356 
mode  of  use,  323,  356 
sponge,  321,  355 
sponge  in  chronic  metritis,  616 
tupelo,  322,  356 

Therapeutics,  general  uterine,  363,  619 
Thrombus  of  the  vulva,  497 
Tissue-forceps,  345 
Tonic,  strychnia,  value  of,  364 
Tonics,  use  of,  630 

Touch,  vesico-vaginal  and  vesico-rectal,  45 
Treatment,  constitutional,  of  chronic  ute- 
rine disease,  363,  619 
moral,  635 

of  atresia  vulvas,  478 
of  atrophy  of  uterus,  618 
of  cervix  during  pregnancy,  567 
of  chronic  metritis,  609,  610,  611 
of  constipation,  390,  627 
of  disorders  of  menopause,  437 
of  dysmenorrhcea,  425 
of  endometritis,  chronic  cervical,  555 
corporeal,  575 
of  epispadias,  477 
of  headache,  634 

of  hypertrophy  of  labia  minora,  477 
of  hypospadias,  477 


Treatment  of  lupus,  523 
of  membranous  dysmenorrhcea,  435 
of  metrorrhagia,  417 
of  nervousness,  634 
of  pelvic  abscess,  727 
adhesions,  51-54 
amenorrhoea,  364,  413 
cellulitis,  60 
hfematoma,  767 
induration,  51 
peritonitis,  702 
of  pruritus  vul  vae,  507 
of  septic  vulva,  332 
wounds,  332 
of  sterility,  468 

of  subinvolution  of  vagina,  671 
of  uterus,  661,  664,  666 
preparatory  to  operations,  336 
Weir  Mitchell’s,  610,  633 
Tubal  pregnancy,  operation  in  rupture  of 
sac,  56 

Tube,  Fallopian  (See  Fallopian  Tube.) 
anatomy  of,  161 
anatomy  of,  minute,  164 
development  of,  87 
malformation  of,  237 
practical  deductions  from  anatom v of, 
165 

surgical  relations  of,  167 
Tubercular  peritonitis,  58,  692 
Tubes,  ovarial,  174 
Tumor  of  labia,  oozing,  531 
Tumors,  diagnosis  from  subinvolution,  658 
in  pelvic  peritonitis,  606 
of  uterus,  causing  subinvolution,  652 
ovarian,  diagnosis  from  hsematocele,  758 
I Twisting  forceps  for  wire,  352 

U. 

Ulceration  of  cervix,  587 
syphilitic,  593 
of  vulva,  494 
Urachus,  88 

Ureter,  malformation  of,  261 
Ureters,  anatomy,  192 
catheterization  of,  195 
surgical  relations  of,  196 
Urethra,  anatomy  of,  183 
gross,  185 
minute,  186 
button-hole  of,  54 
Skene’s  glands  of,  70 
sphincter  muscle  of,  186 
vesical  opening  of,  187 
Urethral  caruncles  as  a cause  of  dyspareu- 
nia,  451 

Urethro-vaginal  fistula,  Parvin’s  opera- 
tion, 38 

Urinary  organs,  anatomy  of,  183 

practical  deductions  from  anatomy  of, 
in  pregnancy,  193 
Urogenital  sinus,  69,  88,  89 
Uterine  appendages,  161 

disease  of,  complicating  dysmenor- 
rlioea,  420 


788 


INDEX  TO  VOLE  ME  I. 


Uterine  decidua,  140 
depletion,  value  of,  379 
disease,  pain  as  a symptom  of,  259 
displacements,  electricity  in,  390 
fibroids  removed  through  anterior  va- 
ginal wall,  56 
fungosities,  594 
hypersemia,  599 
hypertrophy,  599 
massage,  53,  616 
sclerosis,  599 
sound,  302 
subinvolution,  599 
therapeutics,  363,  619 
Uterus,  abnormal  communication,  257 
anatomy,  gross,  134 
minute,  137 

anteflexion  as  malformation,  256 
areuatus  acordiformis,  247 
arrest  of  development  of,  early,  240 
later,  254 

artificial  prolapse  for  diagnosis,  325 

atresia  of,  253 

atrophy  of,  599 

attachment  to  vagina,  150 

bicornis  acollis,  244 

bipartitus,  243 

bleeding  from  external  coat,  153 
cavity  of,  134 
development  of.  87 
didelphys,  245 
dimensions,  132,  152 
double,  in  pregnancy,  252 
relation  to  superfoe  tuition,  353 
duplex  separatus,  244 
excessive  development  of,  239 
foetalis  or  infantilis,  254 
gravid,  injuries  of,  55 
hernia  of,  257 

hyperplasia  of,  electricity  in,  404 
incudiformis,  255 
lymphatics  of,  139,  686 
malformations  of,  238 
in  development,  256 
massage  53,  616 
mobility,  147 

in  pelvic  hsematocele,  759 
of  mucous  membrane  of,  136,  140 
of  cervix,  142 
nerves  of,  140,  142,  146 
obliquity  of,  256 
os  internum,  construction  of,  152 
parts  of,  133 

parvicollis  and  acollis,  256 
position,  131 

as  regards  symptoms,  351 
in  diagnos:s,  300 

practical  deductions  from  anatomy  of, 
147 

in  pregnancy,  193 
piubescens,  255 

relations  to  surrounding  parts,  147 
round  ligament  of,  157 
rudimentary,  242 
septus,  248 

softening  of  tissues,  151 


solid,  242 
sphincter  of,  135 
stenosis,  electricity  in,  405 
subinvolution  of,  637 
subseptus,  249 
unifolis,  250 
supports  of,  221 , 534 
ulceration  of  cervix,  154 
unicollis,  246 

vaginal  extirpation  of.  156 
vessels  and  nerves,  143,  155 
Utricular  glands,  140 

V. 

Vagina,  arteries  and  veins  of,  122 
atresia  of,  257 

as  obstruction  to  coitus,  458 
blind  canals  of,  260 
development  of,  87,  92 
double,  259 

faulty  communications,  260 
malformations  of,  257 
nerves  of,  124 

operations  on.  in  subinvolution  673 
packing  the,  53 

practical  deductions  from  anatomv  of, 
125 

relations  of,  124.  128 

senile  changes  in.  120 

shortness  as  cause  of  dyspareunia,  450 

stenosis  as  cause  of  dyspareunia,  449 

subinvolution  of,  667 

veins  of,  105 

walls  of,  119 

Vaginal  discharge  as  symptom,  292 
examination,  method  of,  298 
extirpation  of  uterus,  156 
hernia,  483 

hysterectomy,  position  for,  128 
ovariotomy,  40,  50 
tampon,  361 
Vaginismus,  51 1 
as  cause  of  dyspareunia,  449 
superior,  515 
Valve  of  Houston,  198 
Varicose  veins  of  vulva.  497 
Vascular  degeneration,  serpiginous,  509 
Veins,  air  in,  from  injections,  583 
of  perineum,  103 
of  vagina,  105 

Venereal  condyloma  of  vulva,  537 
warts  of  vulva,  531 
Ventral  hernia,  60 
Vesico-rectal  examination,  302 
touch,  45 

Vesico-uterine  pouch,  214 
Vesico-vaginal  fistula',  operation  for,  30,  50 
touch,  45 

Vessels  of  the  uterus,  143 
pelvic,  enlargement  of,  156 
obstructions  in,  155 
of  vagina,  122 
and  nerves  of  perineum,  232 
of  uterus,  143,  155 
Vestibule,  anatomy  of,  110 


INDEX  TO  VOLUME  I. 


789 


Vestibule,  bulbs  of,  112 
Viburnum  prunifolium,  49 
Vicarious  menstruation,  415 
Vulsellum  forceps,  342,  349 
Vulva,  alopecia  of,  500,  501 
anatomy  of,  96 
angeioma,  536 
atresia  of,  267 
treatment,  478 
cancer,  carcinoma,  539 
epithelioma,  537 
cancer  of,  537 
cysts  of,  534 
development  of,  92 
eczema,  acute,  503 
chronic,  514 
enchondroma,  536 
erysipelas  of,  504 
erythema,  503 

fibroma  and  fibro-myoma  of,  529 
fibroma  diffusum  of,  526 
gangrene  of,  496 
gaseous  tumors  of,  536 
hnsmatoma  of,  497 
hemorrhage  from,  1 15 
herpes  of,  512 
injuries  and  wounds  of,  479 
from  coitus,  480 
labor,  480 
lipoma  of,  530 
lupus  of,  518 
malformations  of,  264 
melanoma,  536 
myoma  of,  529 
myxoma  of,  530 
nerves  of,  100 
neuroma,  452,  536 
new  growths  of,  518 
oedema,  75,  495 
osteoma  of,  536 
papilloma  of,  530 
pediculosis  pubis  of,  505 
pityriasis  versicolor  of,  504 
pointed  condyloma  of,  531 


Vulva,  practical  deductions  from  anatomy 
of,  114 

prurigo  of,  503 
pruritus  of,  505 
sarcoma,  537 
skin  diseases  of,  501 
syphilitic  warts  of,  534 
thrombus  of,  497 
ulceration  and  fissure,  494 
varicose  veins  of,  497 
warts  of,  530,  531,  534 
Vulvitis  as  cause  of  dyspareunia,  449 
diphtheritic,  492 
follicular,  492 
gonorrhoeal,  492 
phlegmonous,  493 
simple,  490 

Vulvo-vaainal  glands,  anatomy  of,  116 
cysts  of,  534 
gland,  catarrh  of,  499 
inflammation  of,  500 
of  duct,  499 

W. 

Warts  of  vulva,  530,  531,  534 
vulva  caused  by  gonorrhoea,  536 
Water,  hot-,  douche.  (See  Douche.) 

mineral,  value  of,  610 
Weir  Mitchell  treatment,  610,  633 
White  line  in  pelvis,  226 
Wolffian  bodies,  development  of,  73 
ducts,  development  of,  68 
Wounds  of  vulva,  479 
septic,  treatment  of,  332 
Woman’s  Hospital  of  State  of  New  York, 
Alumni  Association  of,  60 
foundation  of,  35 

Z. 

Zinc  as  nerve-tonic,  373 
chloride  in  endocervicitis,  565 
Zona  pellncida,  84,  177 


END  OF  VOLUME  I. 


